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Diabetes in Pregnancy and School-Age Developmental Outcomes for Offspring: A Statewide Retrospective Cohort Study
Hannah G Gordon1,2, Richard J Hiscock1,2, Alexis Shub1,2
1Department of Obstetrics, Gynaecology and Newborn Health, University of Melbourne, Melbourne, Victoria, Australia.
Insights
Pregnancy diabetes (in utero) did not increase developmental vulnerability or educational delays in primary school children. This finding offers reassurance to expectant mothers and healthcare providers regarding neurodevelopmental outcomes.
Area of Science:
- Perinatal medicine
- Developmental pediatrics
- Public health
Background:
- The impact of maternal diabetes on offspring neurodevelopment requires further investigation.
- Existing research has not definitively established links between in utero diabetes exposure and long-term developmental or educational outcomes.
Purpose of the Study:
- To determine if diabetes in pregnancy is associated with developmental vulnerability in early primary school.
- To assess the association between maternal diabetes and educational outcomes in Grade 3.
Main Methods:
- Utilized population-level data from Victoria, Australia (2009-2021) linking birth records with national assessments.
- Defined developmental vulnerability using the Australian Early Development Census (AEDC) and educational outcomes via the National Assessment Program - Literacy and Numeracy (NAPLAN).
- Adjusted for maternal and childhood covariates in statistical analyses.
Main Results:
- No significant association was found between diabetes in pregnancy and overall developmental vulnerability (aRR 1.02 [95% CI 0.98, 1.07]).
- A marginal, clinically insignificant increase in NAPLAN scores was observed (aMD 0.04 [95% CI 0.01, 0.07]).
- Study included 177,898 children for AEDC and 115,231 for NAPLAN data.
Conclusions:
- Diabetes in pregnancy does not appear to be linked to increased developmental vulnerability in children.
- Maternal diabetes exposure did not result in clinically meaningful differences in educational attainment.
- Findings aim to reassure patients and clinicians about neurodevelopmental outcomes.
Objective:
The impact of diabetes in pregnancy on offspring neurodevelopment is unclear. We investigate whether exposure to diabetes in utero is associated with developmental vulnerability or educational delay during primary school.
Research Design And Methods:
We used population-level pregnancy and birth data from 2009 to 2021 from Victoria, Australia, linked with standardized national assessments. Adjusting for a range of maternal and childhood covariates, we investigated whether diabetes in pregnancy was associated with an altered risk of developmental vulnerability compared with no diabetes in the first year of full-time school (ages 4-6 years), defined as below the tenth centile in two or more domains in the Australian Early Development Census (AEDC), and altered educational outcomes in grade 3 (ages 7-8 years), defined as the adjusted mean difference in overall z score in the National Assessment Program - Literacy and Numeracy test (NAPLAN).
Results:
Our study comprised 177,898 children who had linked birth and AEDC data, and 115,231 with linked birth and NAPLAN data, including, respectively, 16,363 (9.2%) and 7,532 (6.5%) exposed to diabetes in pregnancy. Following adjusted analysis, diabetes in pregnancy was not associated with an altered risk of overall developmental vulnerability compared with no diabetes (adjusted relative risk 1.02 [95% CI 0.98, 1.07]). Diabetes was associated with a marginally higher overall NAPLAN z score, but below the prespecified threshold for clinical significance (adjusted mean difference 0.04 [95% CI 0.01, 0.07]).
Conclusions:
Diabetes in pregnancy was not associated with overall developmental vulnerability or a clinically meaningful difference in educational outcomes. This should provide reassurance for patients and their treating clinicians.
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