American Diabetes Association
Supplementary_Tables_for_LOOM_REVISION_April_20,_2024.pdf (419.82 kB)

Long-Term Neurobehavioral and Metabolic Outcomes in Offspring of Mothers with Diabetes During Pregnancy: A large, population-based cohort study in Ontario, Canada.

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posted on 2024-05-31, 19:36 authored by Denice S Feig, Azmina Artani, Ayesha Asaf, Ping Li, Gillian L Booth, Baiju R Shah


Offspring of women with diabetes are at increased risk of developing neurobehavioral and cardio-metabolic disorders, but there is scant evidence regarding the association between glycemic level during pregnancy and these long-term offspring outcomes.

Research Design and Methods

We conducted a population-based, cohort study of deliveries in Ontario between April 1991, and March 2018. Women had pre-existing diabetes, gestational diabetes, or no diabetes. We applied a Cox-proportional hazard model to examine the risk of developing attention deficit hyperactivity disorder (ADHD), autism spectrum disorder (ASD) and cardio-metabolic outcomes in offspring and assessed the association between pregnancy HbA1c levels and risk of outcomes, adjusting for confounders.


3,407,961 mother/infant pairs were followed up to 29 years. Using a Cox proportional hazard model, offspring of women with type 1 diabetes had the highest risk of ADHD (aHR 1.43(1.36-1.49), ASD (aHR 1.94(1.80-2.09), diabetes (aHR 4.73(4.34-5.16), hypertension (adj HR 2.32(2.07-2.61)), and cardiovascular disease (CVD) (aHR 1.72(1.56-1.90)), followed by offspring of women with type 2 diabetes and gestational diabetes compared to those unexposed. Among women with pre-existing diabetes, there was an association between level of pregnancy HbA1c and offspring diabetes (aHR 1.22(1.12-1.32)), hypertension (aHR 1.42(1.29-1.57)), and CVD (aHR 1.20(1.11-1.29)) but no statistically significant association with neurobehavioral outcomes.


In-utero exposure to maternal diabetes was associated with an increase in ADHD, ASD and cardio-metabolic outcomes in offspring, with differences seen across diabetes sub-types. Pregnancy glycemia was associated with cardio-metabolic outcomes, but not neurobehavioral outcomes and provides a potentially modifiable risk factor to decrease cardio-metabolic outcomes in offspring.


This study was funded by a research/educational grant from Sun Life Canada. This study was assisted by ICES, which is funded by an annual grant from the Ontario Ministry of Health (MOH) and the Ministry of Long-Term Care (MLTC). This document used data adapted from the Statistics Canada Postal CodeOM Conversion File, which is based on data licensed from Canada Post Corporation, and/or data adapted from the Ontario Ministry of Health Postal Code Conversion File, which contains data copied under license from ┬ęCanada Post Corporation and Statistics Canada. Parts of this material are based on data and/or information compiled and provided by CIHI and the Ontario Ministry of Health. The analyses, conclusions, opinions, and statements expressed herein are solely those of the authors and do not reflect those of the funding or data sources; no endorsement is intended or should be inferred.