Maternal diabetes in severely obese mothers influences psychiatric disorder risk in offspring

Children of severely obese mothers with diabetes may be at an increased risk for psychiatric disorders, according to findings of a population-based cohort study published in JAMA Network Open.

“These children have a higher risk for developing a psychiatric disorder, such as mood disorders, ADHD and conduct disorders and autism,” Catharina Lavebratt, MSc, PhD, of the Translational Psychiatry Unit at Karolinska University Hospital in Stockholm, told Healio Psychiatry. “The highest risk is seen for children from an obese mother with insulin-treated pregestational diabetes, followed by noninsulin treated type 2 diabetes and gestational diabetes. ”

Although prior research has examined the risk for ASD in the children of this patient population, the researchers noted that little is known about the risk for overweight, moderately obese or severely obese mother with type 2 diabetes to have children who develop mild neurodevelopmental variations and psychiatric conditions apart from ASD. In the present study, the researchers examined the associations of several maternal diabetes types, together and separately with maternal obesity, with psychiatric disorders in the mothers’ children. They collected data from nationwide registries in Finland that encompassed all 649,043 live births between 2004 and 2014 and measured psychiatric diagnoses and prescription of psychotropic drugs among the mothers’ children. They used Cox proportional models to adjust for numerous factors, including birth year, sex, maternal smoking, maternal age and mode of delivery.

Kong and colleagues found that of the 647,099 included births, 4,000 fetuses (0.62%) were exposed to maternal insulin-treated pregestational diabetes, 3,724 (0.57%) were exposed to type 2 diabetes and 98,242 (15.18%) were exposed to gestational diabetes. Further, 34,892 children (5.39%) were later diagnosed with a mild neurodevelopmental or psychiatric disorder. Compared with normal-weight mothers without diabetes, noninsulin treated type 2 diabetes in severely obese mothers was associated with psychiatric disorders in the children (HR = 1.97; 95% CI, 1.64-2.37). However, this association had a lower effect size than that for severely obese mothers with insulin-treated pregestational diabetes (HR = 2.71; 95% CI, 2.03-3.61). The researchers reported the largest effect sizes were for mood disorders, autism and ADHD and conduct disorders. They also noted that gestational diabetes in severely obese mothers had a lower overall effect size (HR = 1.61; 95% CI, 1.5-1.72) and diabetes in normal-weight mothers was not associated with psychopathologic disorder in their children.

“These findings may have implications for counseling and managing pregnancies, in order to prevent obesity and promote a healthy lifestyle in prospective mothers with diabetes,” Lavebratt said. – by Joe Gramigna

Disclosures: The authors report no relevant financial disclosures.