Intrauterine gestational diabetes mellitus, child anxiety, and internalizing symptoms: moderation by physical...

Prenatal exposure to gestational diabetes mellitus (GDM) is linked to increased risk for offspring mental health disorders, yet few studies account for maternal mental health or potential protective factors.

This work aimed to examine whether prenatal GDM exposure is associated with child anxiety and depressive symptoms, independent of maternal depression, and whether child physical activity (PA) modifies these associations.

In this retrospective cohort study, data included 138 child-mother dyads (mean [SD] child age: 11.1 [2.5] years; 40% GDM-exposed; 56% female) from the BrainChild study. GDM status was extracted from electronic medical records. Children completed the State-Trait Anxiety Inventory for Children, Center for Epidemiological Studies Depression Scale for Children, Child Behavior Checklist, and a 3-day PA recall. Mothers completed the Center for Epidemiological Studies Depression Scale. Linear regression models, adjusted for child age, sex, puberty, and maternal depression, assessed associations between GDM exposure and mental health outcomes and tested moderation by moderate-to-vigorous physical activity (MVPA).

GDM-exposed children had higher parent-reported internalizing symptoms compared with unexposed children (β = 3.22; P < .01), independent of maternal depressive symptoms. MVPA significantly interacted with GDM exposure in such a way that the high MVPA group showed no association between GDM exposure and trait anxiety, while the low-MVPA group showed that GDM exposure was associated with higher trait anxiety (β = 4.11; P < .01).

Prenatal GDM exposure was associated with greater internalizing symptoms during preadolescence, independent of maternal depression. Engagement in recommended PA levels mitigated the relationship between GDM-exposure and child anxiety, suggesting PA may protect against anxiety-related outcomes. Future prospective studies are needed to confirm these findings.