Abstract
AIM—To study the neurobehavioural effects that diabetes during pregnancy might have on children by school age. METHODS—The neurobehavioural function of 57 school age children born to 48, well controlled diabetic mothers was compared with 57control children matched for age, birth order, and parental socioeconomic status, using several cognitive, behavioural, sensory and motor neurological tests. RESULTS—The IQ scores of the index group children were similar to those of control children (117.7±13.4 vs 118.5±10.1). There were no differences between the groups in various sensory motor functions. However, the index group children performed less well than the controls on indices of fine and gross motor functions, as observed on the Bruininks-Oseretzky test of motor proficiency. The scores of children born to diabetic mothers were higher than controls on the Touwen and Prechtl neurological examination. They also performed worse in the Pollack tapper test which is designed to detect minor neurological deficits, inattention, and hyperactivity. The index children had higher scores on the Conners abbreviated parent-teacher questionnaire which measures hyperactivity and inattention. There was a negative correlation between the performance of the index group children on various neurodevelopmental and behavioural tests and the severity of hyperglycaemia, as assessed by blood glycosylated haemoglobin and acetonuria. CONCLUSIONS—Diabetes during pregnancy adversely affects some fine neurological functions in children at school age, but not their cognitive scores. These effects are not correlated with the degree of glycaemic control.
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- Accardo P. J., Blondis T. A., Whitman B. Y. Disorders of attention and activity level in a referral population. Pediatrics. 1990 Mar;85(3 Pt 2):426–431. [PubMed] [Google Scholar]
- Blumenthal S. A., Abdul-Karim R. W. Diagnosis, classification, and metabolic management of diabetes in pregnancy: therapeutic impact of self-monitoring of blood glucose and of newer methods of insulin delivery. Obstet Gynecol Surv. 1987 Oct;42(10):593–604. [PubMed] [Google Scholar]
- Cummins M., Norrish M. Follow-up of children of diabetic mothers. Arch Dis Child. 1980 Apr;55(4):259–264. doi: 10.1136/adc.55.4.259. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Eskes T. K., Mooij P. N., Steegers-Theunissen R. P., Lips J. P., Pasker-de Jong P. C. Prepregnancy care and prevention of birth defects. J Perinat Med. 1992;20(4):253–265. doi: 10.1515/jpme.1992.20.4.253. [DOI] [PubMed] [Google Scholar]
- Goto M. P., Goldman A. S. Diabetic embryopathy. Curr Opin Pediatr. 1994 Aug;6(4):486–491. doi: 10.1097/00008480-199408000-00023. [DOI] [PubMed] [Google Scholar]
- Hod M., Diamant Y. Z. The offspring of a diabetic mother--short- and long-range implications. Isr J Med Sci. 1992 Feb;28(2):81–86. [PubMed] [Google Scholar]
- KARK S. L., PERITZ E., SHILOH A., SLOME C. EPIDEMIOLOGICAL ANALYSIS OF THE HEMOGLOBIN PICTURE IN PARTURIENT WOMEN OF JERUSALEM. Am J Public Health Nations Health. 1964 Jun;54:947–960. doi: 10.2105/ajph.54.6.947. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Lambert N. M., Sandoval J. The prevalence of learning disabilities in a sample of children considered hyperactive. J Abnorm Child Psychol. 1980 Mar;8(1):33–50. doi: 10.1007/BF00918160. [DOI] [PubMed] [Google Scholar]
- Metzger B. E., Silverman B. L., Freinkel N., Dooley S. L., Ogata E. S., Green O. C. Amniotic fluid insulin concentration as a predictor of obesity. Arch Dis Child. 1990 Oct;65(10 Spec No):1050–1052. doi: 10.1136/adc.65.10_spec_no.1050. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Miller E., Hare J. W., Cloherty J. P., Dunn P. J., Gleason R. E., Soeldner J. S., Kitzmiller J. L. Elevated maternal hemoglobin A1c in early pregnancy and major congenital anomalies in infants of diabetic mothers. N Engl J Med. 1981 May 28;304(22):1331–1334. doi: 10.1056/NEJM198105283042204. [DOI] [PubMed] [Google Scholar]
- Mills J. L., Baker L., Goldman A. S. Malformations in infants of diabetic mothers occur before the seventh gestational week. Implications for treatment. Diabetes. 1979 Apr;28(4):292–293. doi: 10.2337/diab.28.4.292. [DOI] [PubMed] [Google Scholar]
- Mills J. L., Knopp R. H., Simpson J. L., Jovanovic-Peterson L., Metzger B. E., Holmes L. B., Aarons J. H., Brown Z., Reed G. F., Bieber F. R. Lack of relation of increased malformation rates in infants of diabetic mothers to glycemic control during organogenesis. N Engl J Med. 1988 Mar 17;318(11):671–676. doi: 10.1056/NEJM198803173181104. [DOI] [PubMed] [Google Scholar]
- Mills J. L. Malformations in infants of diabetic mothers. Teratology. 1982 Jun;25(3):385–394. doi: 10.1002/tera.1420250316. [DOI] [PubMed] [Google Scholar]
- Miodovnik M., Mimouni F., Dignan P. S., Berk M. A., Ballard J. L., Siddiqi T. A., Khoury J., Tsang R. C. Major malformations in infants of IDDM women. Vasculopathy and early first-trimester poor glycemic control. Diabetes Care. 1988 Oct;11(9):713–718. doi: 10.2337/diacare.11.9.713. [DOI] [PubMed] [Google Scholar]
- Ornoy A., Uriel L., Tennenbaum A. Inattention, hyperactivity and speech delay at 2-4 years of age as a predictor for ADD-ADHD syndrome. Isr J Psychiatry Relat Sci. 1993;30(3):155–163. [PubMed] [Google Scholar]
- Persson B., Gentz J. Follow-up of children of insulin-dependent and gestational diabetic mothers. Neuropsychological outcome. Acta Paediatr Scand. 1984 May;73(3):349–358. doi: 10.1111/j.1651-2227.1994.tb17747.x. [DOI] [PubMed] [Google Scholar]
- Petersen M. B., Pedersen S. A., Greisen G., Pedersen J. F., Mølsted-Pedersen L. Early growth delay in diabetic pregnancy: relation to psychomotor development at age 4. Br Med J (Clin Res Ed) 1988 Feb 27;296(6622):598–600. doi: 10.1136/bmj.296.6622.598. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Rizzo T. A., Dooley S. L., Metzger B. E., Cho N. H., Ogata E. S., Silverman B. L. Prenatal and perinatal influences on long-term psychomotor development in offspring of diabetic mothers. Am J Obstet Gynecol. 1995 Dec;173(6):1753–1758. doi: 10.1016/0002-9378(95)90422-0. [DOI] [PubMed] [Google Scholar]
- Rizzo T. A., Ogata E. S., Dooley S. L., Metzger B. E., Cho N. H. Perinatal complications and cognitive development in 2- to 5-year-old children of diabetic mothers. Am J Obstet Gynecol. 1994 Sep;171(3):706–713. doi: 10.1016/0002-9378(94)90086-8. [DOI] [PubMed] [Google Scholar]
- Rizzo T., Metzger B. E., Burns W. J., Burns K. Correlations between antepartum maternal metabolism and child intelligence. N Engl J Med. 1991 Sep 26;325(13):911–916. doi: 10.1056/NEJM199109263251303. [DOI] [PubMed] [Google Scholar]
- Schulte F. J., Michaelis R., Nolte R., Albert G., Parl U., Lasson U. Brain and behavioural maturation in newborn infants of diabetic mothers. I. Nerve conduction and EEG patterns. Neuropadiatrie. 1969 Jun-Jul;1(1):24–35. doi: 10.1055/s-0028-1091861. [DOI] [PubMed] [Google Scholar]
- Sells C. J., Robinson N. M., Brown Z., Knopp R. H. Long-term developmental follow-up of infants of diabetic mothers. J Pediatr. 1994 Jul;125(1):S9–17. doi: 10.1016/s0022-3476(94)70170-9. [DOI] [PubMed] [Google Scholar]
- Silverman B. L., Landsberg L., Metzger B. E. Fetal hyperinsulinism in offspring of diabetic mothers. Association with the subsequent development of childhood obesity. Ann N Y Acad Sci. 1993 Oct 29;699:36–45. doi: 10.1111/j.1749-6632.1993.tb18835.x. [DOI] [PubMed] [Google Scholar]
- Stehbens J. A., Baker G. L., Kitchell M. Outcome at ages 1, 3, and 5 years of children born to diabetic women. Am J Obstet Gynecol. 1977 Feb 15;127(4):408–413. doi: 10.1016/0002-9378(77)90499-9. [DOI] [PubMed] [Google Scholar]