Prenatal and perinatal influences on long-term psychomotor development in offspring of diabetic mothers

OBJECTIVE: Our purpose was to assess to what extent disturbances in antepartum maternal metabolism and perinatal complications and morbidities contribute to poorer psychomotor development in offspring of diabetic mothers. STUDY DESIGN: One hundred ninety-six pregnant women and their singleton offspring participated in this prospective cohort-analytic study. Ninety-five women had pregestational diabetes mellitus, and 101 women had gestational diabetes mellitus. Serial estimates of circulating maternal fuels were obtained throughout each index pregnancy along with detailed records of the perinatal course and outcome. Offspring were administered the psychomotor development index of the Bayley Scales of Infant Development at age 2 years and the Bruininks-Oseretsky Test of Motor Proficiency at ages 6, 8, and 9 years. Tests were performed blinded to the mother's antepartum metabolic status, and perinatal history, and the child's previous test scores. Partial correlations and analyses of covariance were used to control for other influences and confounds, such as family socioeconomic status, racial or ethnic origin, patient group (i.e., pregestational or gestational diabetes mellitus), and sex of child. RESULTS: Children's average score on the Bruininks-Oseretsky test at ages 6 to 9 years correlated significantly with maternal second ( p < 0.02) and third trimester ( p < 0.001) β-hydroxybutyrate. There was also a borderline association between the children's scores on the psychomotor development index at age 2 years and maternal third-trimester β-hydroxybutyrate levels ( p = 0.06). No other correlations approached significance. CONCLUSIONS: Intrauterine metabolic experiences continue to influence the neurodevelopmental course in offspring of diabetic mothers. Prevailing practices in diabetes management and obstetric and neonatal care appear to effectively mitigate the potential long-term effects of most perinatal complications and morbidities.