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Prenatal and perinatal influences on long-term psychomotor development in offspring of diabetic mothers
T A Rizzo1, S L Dooley, B E Metzger
1Department of Medicine, Northwestern University Medical School, Children's Memorial Hospital, Chicago, Illinois, USA.
Insights
Maternal metabolic disturbances during pregnancy, specifically elevated beta-hydroxybutyrate, are linked to poorer psychomotor development in children of diabetic mothers. However, current care practices effectively manage most perinatal complications.
Area of Science:
- Endocrinology
- Neurodevelopmental Pediatrics
- Maternal-Fetal Medicine
Background:
- Maternal diabetes mellitus (pregestational and gestational) can impact fetal development.
- Understanding the long-term neurodevelopmental effects on offspring is crucial for optimizing care.
Purpose of the Study:
- To determine the extent to which maternal metabolic status and perinatal factors influence psychomotor development in offspring of diabetic mothers.
- To identify specific metabolic markers associated with neurodevelopmental outcomes.
Main Methods:
- Prospective cohort study of 196 pregnant women with diabetes (pregestational and gestational) and their offspring.
- Serial maternal metabolic fuel measurements and detailed perinatal records.
- Offspring psychomotor development assessed at ages 2 and 6-9 years using standardized tests (Bayley Scales, Bruininks-Oseretsky Test).
Main Results:
- Maternal third-trimester beta-hydroxybutyrate levels significantly correlated with offspring's motor skills at ages 6-9 years (p < 0.001).
- A borderline association was found between third-trimester beta-hydroxybutyrate and psychomotor development at age 2 years (p = 0.06).
- No other significant correlations were observed, indicating a specific metabolic link.
Conclusions:
- Intrauterine metabolic environment, particularly beta-hydroxybutyrate levels, plays a role in the neurodevelopmental trajectory of offspring from diabetic mothers.
- Current obstetric and neonatal care effectively mitigates most adverse outcomes associated with perinatal complications.
- Ongoing research into metabolic management is vital for enhancing long-term neurodevelopmental outcomes.
Objective:
Our purpose was to assess to what extent disturbances in antepartum maternal metabolism and perinatal complications and morbidities contribute to poorer psychomotor development in offspring of diabetic mothers.
Study Design:
One hundred ninety-six pregnant women and their singleton offspring participated in this prospective cohort-analytic study. Ninety-five women had pregestational diabetes mellitus, and 101 women had gestational diabetes mellitus. Serial estimates of circulating maternal fuels were obtained throughout each index pregnancy along with detailed records of the perinatal course and outcome. Offspring were administered the psychomotor development index of the Bayley Scales of Infant Development at age 2 years and the Bruininks-Oseretsky Test Of Motor Proficiency at ages 6, 8, and 9 years. Tests were performed blinded to the mother's antepartum metabolic status, and perinatal history, and the child's previous test scores. Partial correlations and analyses of covariance were used to control for other influences and confounds, such as family socioeconomic status, racial or ethnic origin, patient group (i.e., pregestational or gestational diabetes mellitus), and sex of child.
Results:
Children's average score on the Bruininks-Oseretsky test at ages 6 to 9 years correlated significantly with maternal second (p < 0.02) and third trimester (p < 0.001) beta-hydroxybutyrate. There was also a borderline association between the children's scores on the psychomotor development index at age 2 years and maternal third-trimester beta-hydroxybutyrate levels (p = 0.06). No other correlations approached significance.
Conclusions:
Intrauterine metabolic experiences continue to influence the neurodevelopmental course in offspring of diabetic mothers. Prevailing practices in diabetes management and obstetric and neonatal care appear to effectively mitigate the potential long-term effects of most perinatal complications and morbidities. Management and obstetric and neonatal care appear to effectively miltigate the potential long-term effects of most perinatal complications and morbidities.