The Influence of Gestational Diabetes on Neurodevelopment of Children in the First Two Years of Life: A Prospective Study.
OBJECTIVE
Analyze the relation of gestational diabetes and maternal blood glucose levels to early cognitive functions in the first two years of life.


METHODS
In a prospective Singaporean birth cohort study, pregnant women were screened for gestational diabetes at 26-28 weeks gestation using a 75-g oral glucose tolerance test. Four hundred and seventy three children (n = 74 and n = 399 born to mothers with and without gestational diabetes respectively) underwent neurocognitive assessments at 6, 18, and/or 24 month, including electrophysiology during an attentional task and behavioral measures of attention, memory and cognition.


RESULTS
Gestational diabetes is related to left hemisphere EPmax amplitude differences (oddball versus standard) at both six (P = 0.039) and eighteen months (P = 0.039), with mean amplitudes suggesting offspring of mothers with gestational diabetes exhibit greater neuronal activity to standard stimuli and less to oddball stimuli. Associations between 2-hour maternal glucose levels and the difference in EPmax amplitude were marginal at 6 months [adjusted β = -0.19 (95% CI: -0.42 to +0.04) μV, P = 0.100] and significant at 18 months [adjusted β = -0.27 (95% CI: -0.49 to -0.06) μV, P = 0.014], and the EPmax amplitude difference (oddball-standard) associated with the Bayley Scales of Infant and toddler Development-III cognitive score at 24 months [β = 0.598 (95% CI: 0.158 to 1.038), P = 0.008].


CONCLUSIONS
Gestational diabetes and maternal blood glucose levels are associated with offspring neuronal activity during an attentional task at both six and eighteen months. Such electrophysiological differences are likely functionally important, having been previously linked to attention problems later in life.
Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore, Singapore.
Shirong
http://orcid.org/0000-0002-0650-2234
S
Cai
Singapore Institute for Clinical Sciences, Agency for Science and Technology Research (A*STAR), Singapore, Singapore.|Department of Biomedical Engineering and Clinical Imaging Research Centre, National University of Singapore, Singapore, Singapore.
Anqi
A
Qiu
Singapore Institute for Clinical Sciences, Agency for Science and Technology Research (A*STAR), Singapore, Singapore.|Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore, Singapore.
Birit F P
BF
Broekman
Singapore Institute for Clinical Sciences, Agency for Science and Technology Research (A*STAR), Singapore, Singapore.
Eric Qinlong
EQ
Wong
Singapore Institute for Clinical Sciences, Agency for Science and Technology Research (A*STAR), Singapore, Singapore.|Liggins Institute, University of Auckland, Auckland, New Zealand.
Peter D
PD
Gluckman
MRC Lifecourse Epidemiology Unit and NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom.
Keith M
KM
Godfrey
Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.
Seang Mei
SM
Saw
Singapore Institute for Clinical Sciences, Agency for Science and Technology Research (A*STAR), Singapore, Singapore.|Department of Pediatrics, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore, Singapore.
Shu-E
SE
Soh
Department of Maternal and Fetal Medicine, KK Women's and Children's Hospital, Singapore, Singapore.
Kenneth
K
Kwek
Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore, Singapore.|Singapore Institute for Clinical Sciences, Agency for Science and Technology Research (A*STAR), Singapore, Singapore.
Yap-Seng
YS
Chong
Singapore Institute for Clinical Sciences, Agency for Science and Technology Research (A*STAR), Singapore, Singapore.|Department of Psychiatry, Faculty of Medicine, McGill University, Montreal, Canada.
Michael J
MJ
Meaney
Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore, Singapore.|Department of Epidemiology, Biostatistics and Occupational Health, McGill University Faculty of Medicine, Montréal, Canada.|Department of Pediatrics, McGill University Faculty of Medicine, Montréal, Canada.
Michael S
MS
Kramer
Singapore Institute for Clinical Sciences, Agency for Science and Technology Research (A*STAR), Singapore, Singapore.
Anne
A
Rifkin-Graboi
D000328:Adult; D001288:Attention / Q000502:physiology; D001519:Behavior; D016022:Case-Control Studies; D054022:Cerebrum / Q000503:physiopathology; D002648:Child; D016640:Diabetes, Gestational / Q000503:physiopathology*; D004566:Electrodes; D005071:Evoked Potentials / Q000502:physiology; D005260:Female; D006801:Humans; D007223:Infant; D009420:Nervous System / Q000254:growth & development* / Q000503:physiopathology*; D011247:Pregnancy; D011446:Prospective Studies