Gestational Diabetes Mellitus (GDM) is a condition of high blood sugar levels that starts during pregnancy and usually disappears after pregnancy.
Gestational diabetes gives rise to a lot of short term and long-term complications to the mother as well as the baby. Long term complications of these children like obesity and diabetes are well understood. But how gestational diabetes affects behaviour, intelligence and communication of children is less well understood. Conditions that affect behaviour, intelligence and communication are collectively called neurodevelopmental disorders. Neurodevelopmental disorders tend to occur together. Among them Autism, Attention deficit hyperactive disorder and Learning disability are known to occur together. Autism is a condition characterized by lack of interaction of the child with other people. Attention deficit hyperactive disorder is a condition that affect child’s behaviour. Children with this condition are often restless, and have problems with concentration and act on impulse. Children with learning disability have problems of understanding new or complex information, new skills and coping independently. These conditions have adverse influence on the child as well as the family.
We will perform a matched analysis of pregnant women with and without gestational diabetes to see if there are any differences in these neurodevelopmental outcomes of babies born to mothers with GDM compared to babies born to mothers without GDM.
The aim of this study is to estimate the risk of the neurodevelopmental outcomes of offspring born to mothers with GDM compared to offspring born to mothers without GDM.
A retrospective cohort study between 1990 and 2021 will be conducted to estimate the risk of the neurodevelopmental outcomes of offspring of mothers with and without GDM.
Using the CPRD Pregnancy Register, cohort of pregnant women with and without GDM will be selected. Pregnant women whose GDM diagnosis only in the second or third trimester will be included in the GDM group as earlier classification of GDM includes pregnant women diagnosed as having glucose intolerance at any time during pregnancy. A comparable group of pregnant women without GDM will be selected by matching for age (± 1 year), BMI (± 2 kg/m2) and pregnancy within the same time period (same year) with pregnant women with GDM.
Mother and baby linked data will be used to derive the patient IDs of the babies. Next, neurodevelopmental outcomes of these offspring will be ascertained in CPRD register and risk of neurodevelopmental outcomes of offspring of mothers with and without GDM will be estimated.
Neurodevelopmental outcomes assessed in this study are autism spectrum disorders, attention deficit/hyperactive disorder (ADHD) and learning disabilities. These conditions tend to co-occur. Primary outcome is the incidence risk of all three conditions together and secondary outcomes are the incidence risk of each outcome.
Cox proportional hazards regression model will be used to provide unadjusted and adjusted hazard-ratios (HRs) of the primary and secondary outcomes of offspring of mothers with and without GDM.
GDM is a modifiable risk factor and above three conditions cause significant burden to affected children, families and the health system. Therefore, findings of this research would improve understanding of the disease burden and reorient health services cost effectively.
• Primary outcome
Risk of autism spectrum disorders, attention deficit/ hyperactive disorder, and learning disabilities as a composite measure among offspring born to mothers with GDM compared to offspring born to mothers without GDM
Secondary outcomes
• Risk of autism spectrum disorders
• Risk of attention deficit/ hyperactive disorder
• Risk of learning disabilities
Among offspring born to mothers with GDM compared to offspring born to mothers without GDM
Buddhika Sudasinghe - Chief Investigator - University of Birmingham
Buddhika Sudasinghe - Corresponding Applicant - University of Birmingham
Anuradhaa Subramanian - Collaborator - University of Birmingham
Francesca Crowe - Collaborator - University of Birmingham
Krishna Gokhale - Collaborator - University of Birmingham
Krishnarajah Nirantharakumar - Collaborator - University of Birmingham
Megha Singh - Collaborator - University of Birmingham
Siang Ing Lee - Collaborator - University of Birmingham
CPRD Mother-Baby Link;HES Admitted Patient Care;Pregnancy Register;Patient Level Townsend Index