VIENNA – By age 4 years, the children of women who were overweight or obese before their pregnancy scored 3-4 points below normal on measures of neurocognitive development.
The children showed deficits in motor and memory scales, as well as in general cognition, Dr. Leda Chatzi said at the annual meeting of the European Association for the Study of Diabetes.
Dr. Leda Chatzi
Children whose mothers had gestational diabetes did not exhibit similar decreased cognitive scores. They were, however, significantly more likely to exhibit symptoms of attention-deficit/hyperactivity disorder, said Dr. Chatzi of the University of Crete, Heraklion, Greece.
“These findings have important public health implications, given the increasing prevalence of maternal obesity and gestational diabetes worldwide,” she said.
Dr. Chatzi presented a subanalysis of the Rhea Study, a mother-child birth cohort that began in Crete in 2007 with the aim of investigating the potential risks maternal environment and lifestyle might exert upon offspring – including maternal obesity. It comprises about 1,300 live singleton births. At entry, mothers give urine and blood samples and undergo anthropometric measurements. Cord blood is collected at birth. Mothers and children are followed from birth onward with anthropometrics, psychological and clinical exams, neurodevelopmental testing, and further biological samples. The oldest children in the cohort are now 7 years old; follow-up continues.
Dr. Chatzi’s study comprised 707 mother-child pairs; the children were 4 years old at the time of this analysis. Maternal factors considered in the analysis included fasting glucose and insulin levels at gestational weeks 10-14, body mass index before pregnancy and at the end of the first trimester, and the development of gestational diabetes.
The children underwent several tests of neurocognition, including the McCarthy Scales of Children’s Abilities; the Attentional Deficit Hyperactivity Disorder Test; and the Strengths and Difficulties Questionnaire.
The McCarthy scale includes several subscales: perceptual, quantitative, motor, verbal, memory, and general cognition. A multivariate analysis controlled for the child’s gender, body mass index (BMI), and preschool attendance; maternal demographics and smoking; and the duration of breastfeeding.
At delivery, mothers had a mean age of 30 years; 32% smoked during pregnancy. The infants’ mean gestational age was 38 weeks. Breastfeeding lasted a mean of 4 months.
About one-third of the mothers were either overweight (21%) or obese (13%). Most of those (92%) developed gestational diabetes.
As maternal prepregnancy BMI increased, child scores on general cognition, memory, and motor subscales decreased. The break point for decline below population norms seemed to be between 25 and 30 kg/m2. The children of women whose prepregnancy BMI approached 40 kg/m2 scored a mean of 3-4 points lower on general cognition and the subscales of memory, quantitative, perceptual, and motor performance.
Prepregnancy BMI had no effect on attention-deficit/hyperactivity disorder scores. However, ADHD scores increased significantly in the children of mothers who developed gestational diabetes.
The pathophysiologic link between gestational diabetes and ADHD has never been elucidated, Dr. Chatzi noted. It’s something she intends to investigate. “We’re planning to evaluate these children at later ages, including studying inflammatory markers and potential genetic markers of DNA methylation,” she said.
Dr. Chatzi had no financial disclosures.
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