Impact of breast-feeding on psychomotor and neuropsychological development in children of diabetic mothers: role of the late neonatal period

Long-term Cognitive Implications of Intrauterine Hyperglycemia in Adolescent Offspring of Women With Type 1 Diabetes (the EPICOM Study)

OBJECTIVE

Exposure to maternal diabetes in utero may have a negative impact on the developing brain. The objective was to examine long-term cognitive consequences of intrauterine hyperglycemia in adolescent offspring of women with type 1 diabetes and to ascertain a possible association with maternal HbA1c.

RESEARCH DESIGN AND METHODS

Offspring of a prospectively followed cohort of women with type 1 diabetes (n = 277) participated in a follow-up examination at the age of 13-19 years. A control group from the background population was identified (n = 301). Cognitive function was evaluated using Reynolds Intellectual Assessment Scales and classified into indices of composite intelligence, verbal and nonverbal intelligence, and composite memory. Frequencies of reading and writing problems and attendance to classes for children with learning difficulties were assessed.

RESULTS

Offspring of women with type 1 diabetes scored lower in all normalized and standardized intelligence indices compared with controls: composite intelligence (95.7 vs. 100, P = 0.001), verbal intelligence (96.2 vs. 100, P = 0.004), nonverbal intelligence (96.4 vs. 100, P = 0.008), and composite memory (95.7 vs. 100, P = 0.001). A higher frequency of diabetes-exposed offspring had parent-reported learning difficulties in primary school. Differences between groups remained after adjustment for confounders and potential mediators. We found no direct association between maternal HbA1c and offspring cognitive function in the exposed group.

CONCLUSIONS

Adolescent offspring of women with type 1 diabetes had lower cognitive function compared with a control group, also after adjustment for confounders and potential mediators. These differences may reflect direct harmful effects of maternal diabetes on neurodevelopment in the offspring.

Overweight and school performance among primary school children: the PIAMA birth cohort study

The aim of this study was to assess the association between overweight and school performance among primary school children prospectively and including a broad range of potential confounding factors. In addition it was investigated what factors mediate this association. For this purpose, data of 2,159 12-year-old children who participated in the Prevention and Incidence of Asthma and Mite Allergy (PIAMA) birth cohort study were used. Two indicators of school performance were parental reported when children were 12 years of age and included (i): the score on a standardized achievement test that Dutch children have to complete at the end of their primary education (Cito)-test and (ii): the teacher's advice regarding a child's potential performance level in secondary education. Children's height and weight were measured by a trained research assistant at the age of 8 and by their parents at the age of 12. Overweight was defined using age and gender specific cut-off points. Multivariate regression analyses were performed to assess the association between overweight and school performance. Besides, both confounder and mediation analyses were conducted. Results showed lower Cito-test scores and lower teacher's school-level advice among overweight children. These associations were no longer significant when adjusting for parental educational level, skipping breakfast, and screen time. This study found no independent association between overweight and school performance among primary school children. Results showed strong confounding by parental educational level.

TYPE 1 DIABETES IN PREGNANCY; INFLUENCES ON MOTHER AND FETUS

Type 1 diabetes complicates around 1 in 200 to 300 pregnancies in the United Kingdom. Historically maternal type 1 diabetes carried very high risks for mother and child. Introduction of insulin led to an immediate, marked decline in the previously very high rates of maternal mortality; in contrast an improvement in perinatal outcomes occurred more slowly but was nevertheless dramatic. This is strikingly demonstrated by the temporal decline in perinatal mortality in offspring of mothers with type 1 diabetes which was virtually universal before use of insulin in the 1920's, likely remained in excess of 20% even in the 1960's and fell to under 4% by the 1990's. The reasons for this more gradual improvement in perinatal outcomes cannot be defined with precision but will have been influenced by improved glycaemic management with use of intensive, multiple dose insulin treatment and home glucose monitoring; improvements in obstetric and neonatal management, and better management of complications of diabetes before and during pregnancy. In 1989 the St Vincent declaration proposed that pregnancy outcomes in women with type 1 diabetes should approximate those of the non-diabetic population. While the long term improvements in fetal outcomes have been dramatic, contemporary surveys confirm a persistent doubling or more of rates of congenital anomaly and a three to four fold increase in perinatal mortality in the UK and other European countries which will require further clinical innovation to overcome.