Summary: Children born to mothers with diabetes face significantly higher risks of developing neurodevelopmental disorders, according to a sweeping new meta-analysis involving over 56 million mother–child pairs.
The study, which analyzed 202 research papers, found that maternal diabetes—especially pre-gestational diabetes—is associated with increased odds of conditions such as autism, ADHD, intellectual disability, and learning disorders.
Even after adjusting for various confounding factors, the elevated risk persisted, suggesting that maternal diabetes may play a more direct role in shaping fetal brain development than previously understood.
Key Facts:
- Large-scale Analysis: Review included 202 studies with data from 56,082,462 mother–child pairs.
- Broad Impact: Maternal diabetes was associated with increased risk across all major categories of neurodevelopmental disorders.
- Specific Disorders:
- Autism Spectrum Disorder: 25% increased risk.
- ADHD: 30% increased risk.
- Intellectual Disability: 32% increased risk.
- Learning Disorders, Communication, and Motor Disorders: 16–20% increased risk.
Source: Neuroscience News
A massive new meta-analysis offers the clearest evidence to date that children born to mothers with diabetes face significantly higher risks of developing neurodevelopmental disorders, including autism, attention-deficit hyperactivity disorder (ADHD), and intellectual disabilities.
The findings, drawn from over 56 million mother–child pairs across 202 studies, suggest that both gestational and pre-gestational diabetes can have lasting effects on a child’s cognitive and behavioral development.
Researchers synthesized decades of global data to better understand how maternal diabetes may influence the developing fetal brain.
The results paint a consistent and concerning picture: even after adjusting for major confounding variables such as socioeconomic status, maternal age, and birth complications, maternal diabetes remained robustly associated with a wide spectrum of neurodevelopmental difficulties.
Sweeping Review, Striking Consistency
The systematic review and meta-analysis, registered in PROSPERO and spanning four major research databases, included studies published up to December 2024. Collectively, these studies followed over 56 million mother–child pairs, making this the largest and most comprehensive investigation of its kind.
In studies that adjusted for multiple confounding factors, children exposed to maternal diabetes were:
- 28% more likely to be diagnosed with any neurodevelopmental disorder.
- 25% more likely to be diagnosed with autism spectrum disorder.
- 30% more likely to be diagnosed with ADHD.
- 32% more likely to have intellectual disabilities.
- 16–20% more likely to be diagnosed with learning, communication, or motor disorders.
The pattern held whether the diabetes was gestational (developing during pregnancy) or pre-gestational (existing prior to pregnancy). However, the risk was markedly higher for pre-gestational diabetes.
Children exposed to pre-gestational diabetes had a 39% increased risk of neurodevelopmental disorders, compared to an 18% increased risk among those exposed to gestational diabetes.
Neurodevelopmental Effects Extend Beyond Diagnoses
In addition to clinical diagnoses, children born to mothers with diabetes also showed significantly lower average scores in measures of intelligence and psychomotor development.
These deficits, though variable, suggest that the impact of maternal diabetes may extend well beyond formal diagnostic thresholds, affecting a range of cognitive and motor functions.
The majority of the studies included in the analysis—84%—focused on outcomes in children and adolescents up to the age of 18, providing a long-term view of how early exposures may shape brain function across childhood and adolescence.
Mechanisms and Limitations
While the review did not explore mechanistic pathways directly, prior research has pointed to several plausible biological explanations. These include altered glucose and insulin levels in utero, increased oxidative stress, chronic low-grade inflammation, and epigenetic changes—all of which can interfere with critical periods of fetal brain development.
Importantly, while this meta-analysis demonstrates a strong association, it does not establish causality. The authors caution that additional high-quality, prospective studies are needed to clarify the biological mechanisms at play and disentangle the contributions of genetics, environment, and prenatal metabolic factors.
Still, the consistency of the findings across dozens of studies, populations, and methodologies lends considerable weight to the conclusions.
Public Health Implications
Given the global rise in diabetes and gestational diabetes rates—driven in part by increasing maternal age and obesity—the findings carry major public health implications. Early identification and monitoring of children born to diabetic mothers may allow for timely intervention, potentially improving cognitive and developmental outcomes.
Moreover, the results may inform clinical care guidelines, encouraging tighter glycemic control before and during pregnancy and prompting clinicians to counsel expectant mothers more thoroughly about potential neurodevelopmental risks.
A Call for Continued Research
Despite the strength of the evidence, much remains unknown. Are some neurodevelopmental disorders more sensitive to metabolic disruptions than others? Does the timing of diabetic onset in pregnancy matter? Can interventions during gestation mitigate these risks?
The study’s authors argue that future research should not only explore these questions but also examine potential protective factors and interventions that could buffer developing brains from the effects of maternal metabolic dysfunction.
In the meantime, this research adds urgency to a growing body of literature emphasizing the lifelong consequences of maternal health during pregnancy—not just for mothers, but for their children’s developing brains.
About this gestational diabetes and neurodevelopment research news
Author: Neuroscience News Communications
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Original Research: Closed access.
“Association between maternal diabetes and neurodevelopmental outcomes in children: a systematic review and meta-analysis of 202 observational studies comprising 56·1 million pregnancies” by Wenrui Ye et al. Lancet Diabetes & Endocrinology
Abstract
Association between maternal diabetes and neurodevelopmental outcomes in children: a systematic review and meta-analysis of 202 observational studies comprising 56·1 million pregnancies
Background
Maternal diabetes might alter fetal 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. This study was prospectively registered on PROSPERO (CRD42023395464).
Findings
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>
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.
Funding
The National Natural Science Foundation of China, and the Science and Technology Innovation Program of Hunan Province.
