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Maternal obesity, pregestational diabetes exert joint effects on psychiatric condition in offspring

02 Sep 2018

The combination of maternal pregestational diabetes mellitus (PGDM) plus severe obesity is associated with a heightened risk of several psychiatric and mild neurodevelopmental disorders in offspring compared with either obesity or diabetes alone, a study suggests.

Researchers examined 649,043 live births in Finland between 2004 and 2014. Prepregnancy maternal body mass index (BMI) status was normal for 59.2 percent, overweight for 20.7 percent, obese for 7.67 percent and severely obese for 3.66 percent. The mother had PGDM in 4,000 (0.62 percent) of births and gestational diabetes mellitus (GDM) in 101,696 (15.7 percent).

With respect to offspring outcomes, 34,892 children were diagnosed with a psychiatric disorder; 17,923 had developmental disorders of speech and language, scholastic skills, and motor function; 2,346 had autism spectrum disorder (ASD); 5,263 had attention-deficit/hyperactivity disorder (ADHD) or conduct disorder; 5,301 had mixed disorders of conduct and emotions with childhood onset; 8,506 had other behavioural and emotional disorders; 2,928 had a psychotic, mood, neurotic or stress-related, or somatization disorder; and 279 had eating disorders. Finally, 2,219 had sleep disorders.

A total of 13,436 children had been prescribed a psychotropic medication during the study period, including antipsychotics, hypnotics, anxiolytics, antidepressants and stimulants.

Multivariable Cox proportional hazards analysis revealed that among mothers without diabetes, severe obesity was associated with 67–88-percent increased risk of having a child with mild neurodevelopmental disorders (hazard ratio [HR], 1.69; 95 percent CI, 1.54–1.86), ADHD or conduct disorder (HR, 1.88; 1.58–2.23), and psychotic, mood and stress-related disorders (HR, 1.67; 1.31–2.13) as compared with a normal BMI.

PGDM also contributed to a further risk increase for all groups of psychiatric diagnoses in children (with onset in childhood or adolescence) born to mothers with severe obesity. Large effects were seen for ASD (HR, 6.49; 3.08–13.69), ADHD or conduct disorder (HR, 6.03; 3.23–11.24), and mixed disorders of conduct and emotions (HR, 4.29; 2.14–8.60). There were no significant associations found between GDM and these offspring disorders.

Additional investigation is needed to explore the biological mechanisms by which maternal diabetes and obesity may influence long-term mental and behavioural child health, according to researchers.

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