Gestational Diabetes: Long-Term Central Nervous System Developmental and Cognitive Sequelae

Abstract

Gestational diabetes is a common complication of pregnancy and occurs in approximately 7% of all pregnancies. It has been associated with an increased rate of congenital anomalies including disturbances of intrauterine growth, delayed brain maturity, and neurobehavioral abnormalities in the offspring. The resulting maternal and fetal metabolic dysfunction leads to diminished iron stores (which can affect red blood cell [RBC] production and subsequent organogenesis), a metabolism-placental perfusion mismatch, increased FFA, increased lactic acidosis, and potential hypoxia. Though most newborns born in the context of gestational diabetes are not significantly affected by it, empirical research suggests gestational diabetes has been associated with lower general intelligence, language impairments, attention weaknesses, impulsivity, and behavioral problems. In extreme cases, it may essentially function as a gestational brain insult. Children who are exposed to poorly controlled gestational diabetes may benefit from some form of tracking or follow-up assessments. Additionally, clinicians evaluating children with developmental learning or cognitive dysfunction may want to seek appropriate gestational diabetes-related information from the parents. A greater understanding of this significant gestational risk may help foster improved prenatal diabetes management and may help reduce the neurodevelopmental effects of gestational diabetes.

Effect of ginger on hyperglycemia induced by streptozotocin in pregnant rats and postnatal neurodevelopment of their offspring

“…28 In our study, the offspring of diabetic dams presented neurodevelopmental delay in the negative geotaxis test according to and complementing the cognitive impairments reported by the clinic. 29,24 Furthermore, a decrease in the object recognition index this is in agreement with the results of Kim et al 30 who have demonstrated, with the same experimental model, impaired memory in stepdown avoidance task on PND42.…”

“…Compelling evidence have shown that this maternal type 1 diabetes model can induce microsomia in the offspring, possibly as a result of intrauterine growth restriction with placental commitment, 20,22,23 leading to long-term effects, especially in metabolic and neurologic parameters in the infants. 24,25 The continuation of the hyperglycemic status in diabetic dams (D) after parturition seemed to contribute to the reduced growth during suckle, and pups remained small until weaning age (PND 21) as previously described by Chandna et al 26 The observed effects in offspring may not be only due to the gestational diabetes, but also to the malnutrition at early stages of offspring development, since that maternal type 1 diabetes can delay lactogenesis onset by affecting prolactin secretion and lactose, citrate, and total nitrogen concentrations in the milk. 27 On the other hand, in the offspring of diabetic dams treated with ginger (D + G), our results showed an increase in body weight, which may be due to the decrease in maternal blood glucose after treatment with ginger extract and stimulation of lactation in these dams.…”

Fetal programming of neuropsychiatric disorders

“…Moreover, these children were characterized by a higher rate of inattention and/or hyperactivity. Though most newborns are not significantly affected by gestational diabetes, in clinical practice this condition has been often associated with lower general intelligence, language impairments, attention weaknesses, and behavioral problems (Perna et al, ). Infants born to diabetic mothers show a higher frequency of impaired neurodevelopment, confirming the hypothesis that maternal diabetes may result, at least in some cases, in an insult for the developing fetal brain (Aguilar Cordero et al, ).…”

Macronutrient Preload effect on Glycaemic Control and Pregnancy Outcome in Gestational Diabetes Mellitus

“…However, with the limitation of the small number of patients in our study, there was no statistical difference between the two groups. In addition to increased risks for birth complications recent data also have demonstrated increased risks for children born by mothers with gestational diabetes to develop obesity/diabetes and also neurodevelopmental disorders (ADHD) [25].…”

“…From June 2015 to March 2016, 40 patients (24-28 gestational weeks, singletons) with gestational diabetes mellitus and average age of 32±3.3 years (25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39) were enrolled from the pregnancy nutrition outpatient department of Peking University People's Hospital. The diagnostic criteria for gestational diabetes were according to the IADPPSG standard [6] as accepted by ADA.…”