Effect of maternal gestational diabetes mellitus on neurodevelopment in late preterm infants at the corrected age of 12 months

Abstract

Previous studies have examined the associations of gestational diabetes mellitus(GDM) with autism spectrum disorder and attention deficit hyperactivity disorder. However, the associations between GDM and other neurodevelopmental domains, such as the motor and language, are rarely studied. The primary objective of this study was to examine the effect of maternal GDM on the neurodevelopmental outcomes of late preterm infants at the corrected age of 12 months. This prospective cohort study included 205 late preterm infants born between January 1, 2022, and June 30, 2023 in Jiangsu, China. These infants were grouped according to whether their mothers had GDM, and their neurodevelopment was assessed using the Gesell Developmental Schedules (GDS) at 3, 6, and 12 months of corrected age. Statistical analyses were performed to compare the differences in various parameters between the two groups. A total of 205 infants were enrolled in the study, with 61 in the GDM group and 144 in the non-GDM group. At the corrected age of 3 and 6 months, no significant differences (P > 0.05) were observed in the gross motor, fine motor, adaptability, language, and social-emotional response, nor in rates of abnormal scores, between the GDM and non-GDM groups. However, at the corrected age of 12 months, the GDM group exhibited significantly lower scores in gross motor function and fine motor function compared to the non-GDM group (P < 0.05), while the abnormal rate of language was significantly lower in the GDM group (P < 0.05). Maternal GDM may adversely affect gross motor, fine motor, and language development in late preterm infants at the corrected age of 12 months. These findings highlight the importance of early monitoring and intervention for neurodevelopmental outcomes in this population. Future research should explore the underlying mechanisms and long-term neurodevelopmental trajectories associated with maternal GDM, providing additional insights for clinical practice and public health strategies.

Supplementary Information

The online version contains supplementary material available at 10.1038/s41598-025-98987-w.

Introduction

Gestational diabetes mellitus (GDM) is defined as the first recognition of impaired glucose tolerance during pregnancy. In recent years, despite advancements in diabetes management, the global prevalence of GDM has risen steadily. It is estimated that approximately 20 million neonates worldwide are exposed to intrauterine hyperglycemia every year¹. Late preterm infants are often understudied in the preterm infant population due to their physiological proximity to term infants. Emerging evidence links maternal GDM to both immediate perinatal complications (e.g., macrosomia, neonatal hypoglycemia, respiratory distress syndrome)^2–4, and long-term neurodevelopmental sequelae, such as academic underachievement, attention deficits, and impaired motor coordination⁵. Notably, neonatal hypoglycemia may contribute to neurological morbidity⁶. Despite extensive research on GDM-related developmental outcomes, the effects on specific domains—particularly cognition, language, and motor function in late preterm infants—remain poorly characterized.

Emerging evidence suggests that maternal GDM may disrupt fetal brain development through metabolic alterations, including sustained intrauterine hyperglycemia and subsequent fetal hyperinsulinemia⁷. These perturbations may manifest as subtle neurodevelopmental variations across cognitive, linguistic, motor, and behavioral domains in early childhood. However, the magnitude of these effects, their domain-specific patterns, and moderating factors remain poorly characterized.

To address these gaps, this prospective cohort study investigated the effects of maternal GDM on neurodevelopmental outcomes in late preterm infants at 12 months of corrected age. Using standardized assessments and longitudinal follow-up, we aimed to (1) quantify the association between maternal GDM and domain-specific neurodevelopment, (2) explore potential mediators, (3) inform evidence-based strategies for early risk stratification and personalized interventions to mitigate long-term neurodevelopmental disparities in this vulnerable population.

Materials and methods

Study population

This prospective cohort study enrolled late preterm infants born between January 1, 2022, and June 30, 2023, with ≥ 1 year of follow-up. Inclusion criteria: (1) Gestational age 34 to < 37 weeks; (2) Completion of ≥ 1 year of follow-up at the high-risk infant clinic; (3) Parental/guardian written informed consent; (4) Twin pregnancies without complications.

Exclusion criteria: (1) congenital anomalies or chromosomal abnormalities; (2) Incomplete follow-up data; (3) Maternal pregestational diabetes mellitus (type 1 or 2). Infants were stratified into GDM and non-GDM groups based on maternal GDM status. The study protocol was approved by the Ethics Committee of Zhangjiagang First People’s Hospital (Approval No. ZJGYYL-2021-09-017) and adhered to the Declaration of Helsinki. All parents/guardians provided written informed consent.

Research methods and disease definition

Outcomes and assessments

At discharge, parents were informed of follow-up procedures and scheduled for assessments at corrected ages of 3, 6, and 12 months. A dedicated team conducted standardized neurodevelopmental evaluations using the Gesell Developmental Schedules (GDS), alongside nutritional counseling and early intervention planning.

Relevant definitions

GDM diagnostic standard adopts the diagnostic standard 6 in the 2022 American diabetes Association Guidelines for the Diagnosis and Treatment of Pregnancy Complicated with Diabetes⁸: Glucose tolerance test is conducted at 24–28 weeks of pregnancy, with fasting blood glucose ≥ 5.1 mmol/L, blood glucose ≥ 10.0 mmol/L in one hour, and blood glucose ≥ 8.5 mmol/L in two hours. GDM can be diagnosed if any one of these criteria is met; The standard for neonatal hypoglycemia⁹ is a whole blood glucose level below 2.2mmol/L. When the blood glucose level is below 2.6mmol/L, clinical intervention is required. Transitional hypoglycemia refers to a blood glucose level of 1.5mmol/L < 2.6mmol/L within 1–4 h after birth; Neonatal respiratory distress syndrome(NRDS)⁹ is a clinical syndrome characterized by respiratory distress occurring shortly after birth and progressively worsening due to a lack of pulmonary surfactant. Neonatal sepsis¹⁰ is a grave infectious disease. It pertains to a systemic infection that occurs when pathogens invade the bloodstream, multiply therein, and produce toxins. The diagnosis of neonatal sepsis can be categorized into suspected diagnosis, clinical diagnosis, and confirmed diagnosis; Necrotizing enterocolitis (NEC)⁹ in newborns is mainly characterized by abdominal distension, bloody stools, and vomiting. In severe cases, shock and multiple organ failure may occur. Abdominal X-ray plain films are characterized by partial intestinal wall cystic gas accumulation, and pathology is characterized by necrosis of the distal ileum and proximal colon; Periventricular-intraventricular hemorrhage(PVH-IVH): According to Papile grading diagnosis: Grade I: simple subarachnoid hemorrhage or accompanied by minimal intraventricular hemorrhage; Grade II: Bleeding into the ventricles of the brain; Grade III: intraventricular hemorrhage with ventricular dilation; Grade IV: intraventricular hemorrhage with periventricular hemorrhagic infarction.

Outcome and monitoring indicators

Clinical data of late preterm infants were collected, including gestational age, birth weight, sex, twin and multiple births, mode of delivery, small for gestational age, neonatal asphyxia, neonatal respiratory distress syndrome (NRDS), neonatal sepsis, neonatal hypoglycaemia, necrotising enterocolitis (NEC), intracranial hemorrhage, hypothyroidism, and physical growth at 12 months of age. Clinical data of pregnant women were also collected, including maternal age at delivery, educational level, maternal occupation, socioeconomic status, smoking status, gestational weight gain, cholestasis, hypothyroidism, anaemia, spontaneous preterm labour, chorioamnionitis, gestational hypertension, and premature rupture of membranes (PROM) ≥ 18 h.

Neurodevelopmental assessment was conducted by trained paediatricians using the GDS Chinese Revised Edition (revised by the Beijing Children’s Hospital Health Centre)¹¹ at the corrected ages of 3, 6, and 12 months. The scale has been standardised and widely applied in mainland China, demonstrating adequate validity and high reliability^12–14. The assessments was performed by two qualified physicians from our hospital. During the evaluation, each infant was placed in a separate, quiet, comfortable, and undisturbed consultation room, and the infant was in good spirits.

The developmental quotient (DQ) consists of five functional domains: Gross Motor, Fine Motor, Adaptability, Language, and Social-Emotional Response, totalling 512 items. The DQ is calculated as follows:

In this study, a DQ of ≤ 75 was uniformly defined as abnormal.

Statistical analysis

SPSS 25.0 statistical software was used to perform statistical analyses on the data. Data following a normal distribution were presented as mean ± standard deviation (±s) and compared between groups using the t-test. Non-normally distributed data were expressed as median (P25, P75) and analysed with the Mann–Whitney U test. Categorical data were reported as frequencies and percentages (%) and compared between groups using the χ² test (chi-square test), Yates’ corrected χ² test, or Fisher’s exact test, as appropriate. A two-tailed P < 0.05 was considered statistically significant.

Results

General characteristics of late preterm infants and pregnant mothers

From January 2022 to June 2023, 223 late preterm infants were delivered at our hospital. Following discharge, five cases were lost to follow-up due to changes in contact information or addresses, while 13 cases declined further participation owing to limited parental awareness. Ultimately, 205 late preterm infants were included in the final analysis: 61 in the GDM group and 144 in the non-GDM group (Table 1). The median gestational age was 36 weeks (interquartile range [IQR]: 35.3–36.6), with a mean birth weight of 2575 ± 370 g. The cohort comprised 124 males (60.5%) and 81 females (39.5%). Singleton births accounted for 162 cases (79.0%), with the remaining 43 cases (21.0%) being twin or multiple births. Vaginal delivery occurred in 151 cases (73.7%), compared to 54 cases (26.3%) delivered by caesarean section. Low Apgar scores (≤ 7) were observed in eight cases (3.9%) at 1 min and one case (0.5%) at 5 min. No statistically significant differences were found between the GDM and non-GDM groups regarding gestational age, birth weight, sex distribution, birth plurality (singleton vs. multiple births), delivery mode, small-for-gestational-age status, Apgar scores, or neonatal complications (P > 0.05), as indicated in Table 1.

Table 1.

Comparison of general and maternal conditions between two groups of late premature infants.

Characteristics	GDM group (n=61)	Non-GDM group (n=144)	t/χ2/Z	P value
Newborns
Gestational age (week)	35.9 ± 0.8	36(36.3, 36.6)	− 0.324	0.746
Birth weight (kg)	2.64 ± 0.35	2.55 ± 0.38	1.571	0.118
Sex
Male	38 (62)	86 (60)	0.119	0.730
Female	23 (38)	58 (40)
Twin and multiple births	14 (23)	29 (20)	0.204	0.651
Caesarean section	14 (23)	40 (28)	0.515	0.473
Small for gestational age	2 (3)	3 (2)		0.635*
Apgar scoring ≤ 7points
1 min	4 (7)	4 (3)		0.241*
5 min	0 (0)	1 (1)		1.000*
Neonatal complications
NRDS	9 (15)	10 (8)	2.464	0.116
Sepsis	2 (3)	3 (2)		0.635*
Hypoglycemia	5 (8)	5 (4)		0.167*
NEC	0 (0)	1 (1)		1.000*
Intracranial hemorrhage	1 (2)	0 (0)		0.298*
Hypothyroidism	0 (0)	0 (0)		–
Physical growth at 12 months of age
Weight (kg)	10.11 ± 1.05	10.23 ± 1.00	− 0.735	0.463
Height (cm)	75.95 ± 2.57	76.16 ± 2.58	− 0.547	0.585
Head circumference (cm)	45.64 ± 1.25	45.96 ± 1.12	− 1.089	0.072
Pregnant women
Maternal age at delivery (years)	31.18 ± 5.04	29.92 ± 4.64	1.727	0.086
Educational level
Primary school or below	2 (3)	2 (1)	1.180	0.758
Junior high school	22 (36)	59 (41)
Senior high school	21 (34)	45 (31)
College	16 (26)	38 (26)
Maternal occupation
Mental work	17 (28)	42 (29)	0.372	0.830
Physical work	23 (38)	48 (33)
Others	21 (34)	54 (38)
Socioeconomic status
< RMB5000 per month	8 (13)	19 (13)	0.400	0.940
RMB5000-20000 per month	37 (61)	85 (59)
RMB20000-50000 per month	14 (23)	37 (26)
> RMB50000 per month	2 (3)	3 (2)
Smoking	3 (5)	5 (3)		0.697*
Gestational weight gain (kg)	16.8 ± 5.6	16.5 ± 6.1	0.330	0.742
Cholestasis	6 (10)	8 (6)		0.362*
Hypothyroidism	12 (20)	16 (11)	2.663	0.103
Anaemia	4 (7)	8 (6)		0.753*
Obesity	2 (3)	2 (1)		0.584*
Spontaneous Preterm labor	49 (80)	121 (84)	0.414	0.520
Chorioamnionitis	1 (2)	1 (1)		0.508*
Gestational hypertension	7 (11)	13 (9)	0.292	0.589
PROM ≥ 18 h	3 (5)	6 (4)		0.727*

NRDS neonatal respiratory distress syndrome, NEC necrotizing enterocolitis, PROM premature rupture of membrane.

*Accurate calculation method is used for testing.

Regarding neonatal complications, 19 cases (9.3%) developed respiratory distress syndrome, 5 cases (2.4%) had sepsis, and 59 cases (28.8%) experienced hypoglycaemia. NEC occurred in 1 case (0.5%), as did intracranial haemorrhage (0.5%), while no cases (0%) of hypothyroidism were observed. No statistically significant differences in postnatal complications were found between the two groups of late preterm infants (P > 0.05). All 59 cases of neonatal hypoglycaemia were transient in nature. The single NEC case was classified as Bell stage II, and the intracranial haemorrhage case was confined to the subarachnoid space without ventricular extension, as presented in Table 1.

Among the 61 mothers with GDM, 12 received insulin therapy, 4 were treated with metformin, and 45 managed with dietary control. Glycaemic control was achieved in 49 cases (80.3%), while 12 cases (19.7%) showed suboptimal control. No statistically significant differences were observed between the groups regarding maternal characteristics, including: age at delivery; educational level; occupation; socioeconomic status; smoking; gestational weight gain; or comorbidities (cholestasis, hypothyroidism, anaemia, obesity, spontaneous preterm labour, chorioamnionitis, gestational hypertension, and PROM ≥ 18 h) (P > 0.05), as detailed in Table 1.

GDS comparison between two groups of late preterm infants

At the corrected age of 12 months, Infants in the GDM group exhibited significantly lower gross motor (DQ: 89.9 ± 9.8 vs. 92.7 ± 9.2, P = 0.045) and fine motor (DQ: 87.8 ± 9.8 vs. 91.0 ± 10.5, P = 0.039) scores compared to the non-GDM group, and the GDM group also had a higher rate of language developmental abnormalities (14.8% vs. 5.6%, P = 0.029). However, no statistically significant differences were observed between groups at corrected ages of 3 and 6 months across any developmental domains, including gross motor, fine motor, adaptability, language, and social-emotional response (P > 0.05), as demonstrated in Table 2.

Table 2.

GDS comparison between two groups of late preterm infants.

Gesell		GDM group (n=61)	Non-GDM group (n=144)	t/χ2	P value
At the corrected age of 3 months
Gross motor	DQ	86.3 ± 11.0	88.2 ± 12.6	− 1.039	0.300
	na (%)	8 (13)	15 (10)	0.313	0.576
Fine motor	DQ	86.7 ± 15.4	88.2 ± 12.3	− 0.750	0.454
	na (%)	6 (10)	10 (7)		0.570*
Adaptablity	DQ	86.0 (81.0, 93.0)	84.0 (79.0, 92.0)	− 1.283	0.199
	na (%)	7 (11)	17 (12)	0.005	0.946
Language	DQ	88.3 ± 13.4	90.8 ± 15.2	− 1.142	0.255
	na (%)	5 (8)	12 (8)	0.001	0.974
Social-emotional response	DQ	83.3 ± 12.3	86.0 (80.0, 92.8)	− 1.267	0.205
	na (%)	7 (11)	17 (12)	0.005	0.946
At the corrected age of 6 months
Gross motor	DQ	88.9 ± 10.7	87.7 ± 9.1	0.842	0.401
	na (%)	5 (8)	9 (6)		0.763*
Fine motor	DQ	86.1 ± 7.1	88.2 ± 9.7	− 1.490	0.138
	na (%)	4 (7)	12 (8)		0.782*
Adaptablity	DQ	85.4 ± 9.8	87.0(81.0, 93.0)	− 0.858	0.391
	na (%)	3 (5)	5 (4)		0.697*
Language	DQ	89.5 ± 11.0	91.7 ± 11.8	− 1.207	0.229
	na (%)	4 (7)	6 (4)		0.488*
Social-emotional response	DQ	87.3 ± 9.8	89.5 ± 11.3	− 1.324	0.187
	na (%)	3 (5)	7 (5)		1.000*
At the corrected age of 12 months
Gross motor	DQ	89.9 ± 9.8	92.7 ± 9.2	− 2.014	0.045
	na (%)	3 (5)	6 (4)		0.727*
Fine motor	DQ	87.8 ± 9.8	91.0 ± 10.5	− 2.082	0.039
	na (%)	4 (7)	5 (3)		0.455*
Adaptablity	DQ	90.9 ± 7.0	93.0 ± 8.9	− 1.578	0.116
	na (%)	2(3)	3(2)		0.635*
Language	DQ	85.9 ± 10.8	88.5 ± 8.4	− 1.667	0.099
	na (%)	9 (15)	8 (6)	4.767	0.029
Social-emotional response	DQ	92.1 ± 8.3	92.4 ± 8.5	− 1.613	0.108
	na (%)	1 (2)	3 (2)		1.000*

^*Accurate calculation method is used for testing. Bold characters of P value indicate statistically significant differences.

GDS comparison at 12 months old between two groups of late preterm infants stratified by gestational age

Among 34 W ≤ GA < 35 W, the language DQ scores of the GDM group were lower than those of the non-GDM group, among 35 W ≤ GA < 36 W, the gross motor DQ scores of the GDM group were lower than those of the non-GDM group, among 36 W ≤ GA < 37 W, the fine motor DQ scores of the GDM group were lower than those of the non-GDM group, with statistically significant differences (P < 0.05); However, there was no statistically significant difference (P > 0.05) in the scores of adaptability, social-emotional respons and abnormality rates, as presented in Table 3.

Table 3.

GDS comparison at 12 months old between two groups of late preterm infants stratified by gestational age.

Group	N	Gross motor		Fine motor		Adaptablity		Language		Social-emotional response
		DQ	na (%)	DQ	na (%)	DQ	na (%)	DQ	na (%)	DQ	na (%)
34 W ≤ GA < 35 W
GDM	10	95.80 ± 8.44	0 (0)	87.80 ± 11.78	2 (20)	88.80 ± 11.46	1 (10)	81.10 ± 10.27	2 (20)	92.20 ± 7.89	0 (0)
Non-GDM	27	92.33 ± 10.48	2 (7)	90.78 ± 15.57	2 (7)	93.33 ± 8.21	0 (0)	89.44 ± 9.13	1 (4)	91.78 ± 9.33	1 (4)
t/χ2		0.937		− 0.548		− 1.337		− 2.389		0.127
P		0.355	1.000*	0.578	0.291*	0.190	0.270*	0.022	0.172*	0.900	1.000*
35 W ≤ GA < 36 W
GDM	18	85.78 ± 11.67	1 (6)	88.94 ± 8.97	1 (6)	91.56 ± 6.50	1 (6)	87.72 ± 11.66	3 (17)	91.94 ± 10.41	1 (6)
Non-GDM	42	91.83 ± 9.31	2 (5)	89.67 ± 9.37	2 (5)	93.40 ± 6.73	0 (0)	89.48 ± 8.00	2 (5)	96.48 ± 7.64	0 (0)
t/χ2		− 2.136		− 0.277		− 0.985		− 0.675		− 1.882
P		0.037	1.000*	0.783	1.000*	0.329	0.300*	0.502	0.154*	0.065	0.300*
36 W ≤ GA < 37 W
GDM	33	90.27 ± 8.16	2 (6)	87.03 ± 9.90	1 (3)	91.24 ± 5.52	0(0)	86.30 ± 10.46	4 (12)	92.18 ± 7.40	0 (0)
Non-GDM	75	93.40 ± 8.76	2 (3)	91.84 ± 8.88	1 (1)	92.56 ± 10.16	3(4)	87.55 ± 8.27	5 (7)	93.80 ± 8.51	2 (3)
t/χ2		− 1.744		− 2.503		− 0.869		− 0.655		− 0.946
P		0.084	0.584*	0.014	0.520*	0.387	0.551*	0.514	0.451*	0.346	1.000*

^*Accurate calculation method is used for testing. Bold characters of P value indicate statistically significant differences.

Discussion

The ecological framework of the Developmental Origins of Health and Disease (DOHaD) hypothesis proposes that childhood development and disease susceptibility are frequently modulated by early environmental exposures¹⁵. The intrauterine environment during gestation may influence neurodevelopmental outcomes through effects on fetal brain development. Previous research has identified associations between maternal GDM and poorer performance across cognitive and memory measures in children aged 1 year to school age¹⁶. However, other studies have reported no significant correlation between neuromotor development and either maternal GDM or elevated gestational blood glucose levels¹⁷.Our study demonstrates that late-preterm infants exposed to maternal GDM showed significantly lower gross motor, fine motor, and language abilities at 12 months’ corrected age compared to non-GDM-exposed infants.

In terms of motor, the relationship between GDM and offspring motor development has been investigated in multiple case-control^18,19 and cohort studies^20–22, with inconsistent conclusions. Bersain et al.²³ and Diana et al.²⁴ reported significantly lower psychomotor and mental development indices in children of mothers with GDM, particularly those born to mothers with pre-existing type 1 or type 2 diabetes, with pronounced effects observed at 12 months of age. A meta-analysis of 13 studies²⁵ further demonstrated that maternal GDM was associated with impaired motor development (including both gross and fine motor skills), with more severe deficits observed in offspring of mothers with pre-pregnancy diabetes, potentially attributable to prolonged exposure to hyperglycaemia. In contrast, Loeb et al.²⁶ found no significant differences in gross or fine motor abilities between preterm infants of GDM mothers and controls. Given the limited and inconclusive evidence regarding GDM’s effects on infant motor development, further research is needed to clarify this relationship. Our study revealed that late preterm infants exposed to maternal GDM exhibited significantly lower gross motor scores (DQ: 89.9 ± 9.8 vs. 92.7 ± 9.2, P = 0.045) and fine motor scores (DQ: 87.8 ± 9.8 vs. 91.0 ± 10.5, P = 0.039) at 12 months’ corrected age compared to non-exposed infants, consistent with Bersain et al.’s findings. Mechanistically, intrauterine hyperglycaemia may disrupt neural circuitry by exacerbating peripheral and neuroinflammation, thereby impairing neuronal growth, migration, and differentiation, ultimately delaying motor development²⁷.

In terms of language, current evidence presents conflicting findings regarding GDM and offspring language development, with some studies demonstrated significant impairments^26,28 while others reported no association^29,30. Potential mechanisms may involve GDM-induced placental vascular abnormalities causing fetal cerebral hypoperfusion, metabolic disturbances (hyperinsulinaemia, chronic hypoxia)^27,31–33, and reduced brain-derived neurotrophic factor (BDNF) levels²⁸. Our study corroborates previous reports of increased language delay risk in GDM-exposed infants at 12 months’ corrected age. So, for infants of GDM mothers, attention should be paid to monitoring their language development, and relevant screening and intervention should be carried out as soon as necessary. In addition, brain-derived neurotrophic factor may become an early screening indicator for abnormal language development of infants of mothers with GDM.

Although we identified the impact of maternal GDM on the corrected development of late preterm infants at the corrected age of 12 months, no differences were found in the scores of each functional area between the two groups at 3 and 6 months. These findings indicate that late preterm infants exposed to maternal GDM constitute a high-risk population for gross motor, fine motor, and language impairments, necessitating developmental surveillance through 12 months’ corrected age. A prior US study³⁴ associated GDM with a higher language disorder risk. A longitudinal study of 243 mother - infant pairs¹⁶ showed GDM was linked to weaker language development in 2 - year - olds, with pregnant mothers’ metabolic status and diet significantly affecting children’s neurological development. Further longitudinal research is needed to clarify the long - term developmental trajectory of GDM exposed infants, elucidate the mechanisms connecting maternal GDM to offspring neurodevelopment, and establish evidence - based monitoring protocols for this high - risk group.

Strengths and limitations

This study adopted a prospective cohort study design, which allows for real-time observation of the subjects and timely collection of data, reducing recall bias. Moreover, the GDS has been standardized and widely applied in Mainland China. It has good validity and high reliability, and can relatively accurately assess the neurodevelopment of late preterm infants. However, there are also certain limitations. The sample size is relatively small, making it difficult to comprehensively reflect the overall situation. In addition, the study did not conduct a multivariate analysis, so it is unable to deeply explore the influence of the complex interactions among multiple factors on the neurodevelopment of late preterm infants. Future research needs to expand the sample size and adopt more complex research methods such as multivariate analysis to more accurately clarify the mechanism of the impact of GDM on the neurodevelopment of late preterm infants, providing a more solid theoretical basis for early intervention and improvement of prognosis.

Conclusion

Maternal GDM may adversely affect gross motor, fine motor, and language development in late preterm infants at the corrected age of 12 months. These findings highlight the importance of early monitoring and intervention for neurodevelopmental outcomes in this population. Future research should explore the underlying mechanisms and long-term neurodevelopmental trajectories associated with maternal GDM, providing additional insights for clinical practice and public health strategies.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Author contributions

Lidan Qian chose the topic. Jialin Zhu, Xin Tiantian, Weidong Xu provided methodological support. Lidan Qian completed the subsequent data analysis and article writing. Jialin Zhu provided guidance and assistance throughout the process. All authors revised the manuscript for important intellectual content, participated in the decision to submit the manuscript for publication, and approved the fnal submitted version.

Funding

Zhangjiagang Health Youth Science and Technology Project(ZJGQNKJ202416).

Data availability

Data is provided within the manuscript or supplementary information files.

Declarations

Competing interests

The authors declare no competing interests.