Experts have issued reassurances after a recent study where researchers reviewed data from 56.1m pregnancies to probe possible connections between diabetes and ADHD, autism and intellectual disability.
The scientists found that in fact, maternal diabetes during pregnancy increased the risk of a baby developing a neurodevelopmental disorder by 28%, but medical experts say the findings reinforce how important it is to take good care of diabetes during pregnancy to lower the chances of giving birth to a child with a disability.
The evidence confirms the importance of controlling diabetes, eating a nutritious diet, and exercising during pregnancy, they added.
The study results, published in The Lancet Diabetes and Endocrinology, suggested a slightly higher risk for ADHD and intellectual disability than autism.
The researchers had examined data from nearly 205 studies on 56.1m pregnancies worldwide, their aim being to determine how children – whose parents had type 1, type 2, or gestational diabetes while pregnant – fared.
What they discovered is that babies born to those who had diabetes in pregnancy were 28% more likely to have a neurodevelopmental issue like ADHD or autism than pregnant people without the condition. Having diabetes before pregnancy also increased the risk, reports the journal Parents.
“This study shows an association with an increased risk of neurodevelopmental disorders and impaired neurodevelopmental performance in children of mothers with diabetes,” said Anushka Chelliah, MD, a board-certified maternal-foetal medicine specialist at Pediatrix Medical Group in Texas.
Chelliah said the study did not say that diabetes causes any of these neurodevelopmental disorders, but suggests “a need for further research to clarify the associations between specific types of diabetes and the full spectrum of neurodevelopmental disorders”.
Is there a reason to worry?
According to Todd Rosen, MD, a maternal-foetal specialist with RWJBarnabas Health in New Jersey who is not affiliated with the study, said diabetes during pregnancy can be risky, but the results of the research were no cause for panic.
The study, he said, included pregnancies in women who may have had poorly controlled diabetes. Even in this mixed group, babies born to women with diabetes were still more likely to be healthy and be born without disability.
“The message for parents is that it is important to take good care of diabetes during pregnancy to lower the chances of a child who is born with disability.”
Overall, researchers are unsure why diabetes increases the risk of ADHD and other neurodevelopmental conditions. Nor do they know whether or not better blood sugar control could reduce these risks.
Regardless, the experts say having diabetes in pregnancy has long been linked to other complications.
“For the baby, being exposed to high levels of sugar can contribute to birth defects, like issues with the development of the foetal heart and skeleton,” said Rachel Newman, MD, MBA, an assistant professor and maternal-foetal medicine physician with UTHealth Houston.
“These structural differences can range from mild to severe, which is why good glucose control, especially when the baby’s body parts are forming early in pregnancy, is so important.”
In terms of maternal health, Newman said having diabetes can also increase the risk of developing blood pressure issues in pregnancy, having a preterm birth, or requiring a Caesarean section.
“In pregnancy, there are only so many things that we can control,” she added. “If a woman has diabetes in pregnancy, doing the best she can to keep her glucose in the normal range will help protect her and her baby, but she needs to recognise that there are times when the body doesn’t always co-operate.”
Study details
Association between maternal diabetes and neurodevelopmental outcomes in children: a systematic review and meta-analysis of 202 observational studies comprising 56·1 million pregnancies
Wenrui Ye, Cong Luo, Jun Zhou et al.
Published in The Lancet on 7 April 2025
Summary
Background
Maternal diabetes might alter foetal brain development. However, well-designed systematic analyses are needed to comprehensively assess and quantify the association between maternal diabetes and neurodevelopmental outcomes in children. We aimed to synthesise and evaluate the available evidence on the effects of maternal diabetes on neurodevelopmental outcomes in children.
Methods
For this systematic review and meta-analysis we searched PubMed, Web of Science, Embase, and EBSCO databases from inception to Dec 1, 2024, for studies exploring neurodevelopmental outcomes of children born to mothers with diabetes. The primary outcome was neurodevelopmental disorders, as defined by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition and International Classification of Diseases 11th Revision. Data were extracted from published reports. Data were pooled with random-effects models and presented as risk ratios or standard mean differences with 95% CIs.
Findings
A total of 202 studies, involving 56 082 462 mother–child pairs, were included in the meta-analysis. Of these, 110 (54%) examined gestational diabetes, while 80 (40%) investigated pre-gestational diabetes. Among the total studies reviewed, 169 (84%) exclusively focused on children and adolescents aged up to 18 years. In studies adjusting for at least one key confounder, maternal diabetes was associated with increased risks of all types of neurodevelopmental disorders as well as lower intelligence and psychomotor scores. In studies adjusting for multiple confounders (n=98, 49%), children exposed to maternal diabetes had an increased risk of any neurodevelopmental disorder (risk ratio 1·28; 95% CI 1·24–1·31), autism spectrum disorder (1·25; 1·20–1·31), attention-deficit hyperactivity disorder (1·30; 1·24–1·37), intellectual disability (1·32; 1·18–1·47), specific developmental disorders (1·27; 1·17–1·37), communication disorder (1·20; 1·11–1·28), motor disorder (1·17; 1·10–1·26), and learning disorder (1·16; 1·06–1·26), compared with unexposed children. Maternal pre-gestational diabetes was more strongly associated with the risk of most neurodevelopmental disorders in children than gestational diabetes (risk ratio 1·39; [95% CI 1·34–1·44] vs 1·18 [1·14–1·23]; subgroup difference p<0·0001).
Interpretation
Maternal diabetes is associated with an increased risk of neurodevelopmental disorders and impaired neurodevelopmental performance in children. Further high-quality research is needed to establish causality and clarify the associations between specific types of diabetes and the full spectrum of neurodevelopmental disorders.
See more from MedicalBrief archives:
Nuts-rich diet in first trimester linked to improved neuro-development in child
Genetic variants that increase ADHD risk discovered
AI analysis IDs warning signs for stillbirth, newborn issues