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 Overall, children born to mothers with type 1 diabetes achieved
similar grades in primary school when compared to other children,
the study found, but for the children of diabetic mothers, academic
achievement was “quite divergent” depending on how well mothers had
controlled their blood sugar before and during pregnancy.
The study authors caution in the journal Diabetes Care that it’s not
clear if exposure to high blood sugar levels during pregnancy
affected children’s brains directly, or family factors that affected
mothers’ ability to control their blood sugar also influenced
children’s cognitive development.
“Good diabetes control prior to and during pregnancy is important in
other ways, as it lowers the risk of birth defects, preeclampsia,
preterm delivery, large birthweight babies, and low blood sugar in
the newborn,” said Dr. Florence Brown, director of the Joslin
Diabetes Center - Beth Israel Deaconess Diabetes and Pregnancy
Program in Boston, who was not involved in the study.
“But when we see an association between maternal higher (blood
sugar) in pregnancy and worse offspring academic achievement we
cannot say that there is cause and effect,” Brown said in an email.
“While the authors try to adjust for the effect of parental
education on child educational performance, there may be other
factors that influence offspring academic achievement.”
The study authors, led by Dr. Sine Knorr at Aarhus University
Hospital, looked at medical records to track blood sugar levels
pre-pregnancy and during pregnancy for women with type 1 diabetes,
and used school records to follow the performance of 707 of their
primary-school-age children.
They also compared those children to more than 60,000 similar school
children whose mothers did not have diabetes.
Children born to women with good control of their blood sugar tended
to have better than average grades as compared to their peers in the
general population. This was particularly true for the children of
women who maintained good blood sugar control during their third
trimester of pregnancy.
But the reverse was also true. When mothers had poor control of
their diabetes before and during their pregnancy, their children had
lower grades. The poorer the control, the worse children did in
school, when they were compared to the offspring of women without
diabetes.
The study team also found that there was a strong relationship
between the mother’s level of education and her blood sugar control.
The more educated women were, the better they seemed to be at
controlling their diabetes.
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There was also a strong association between parental education and
their children’s school grades, but even after the authors took that
into account, the relationship between blood sugar control in
pregnancy and kids’ school grades persisted.
Brown pointed out that a mother’s social, psychological and
cognitive function beyond her educational attainment would be
expected both to improve her diabetes control and enrich the
learning environment of her child.
“This is supported by the fact that women with the best diabetes
control . . . in pregnancy had offspring that performed better
academically than offspring of . . . women without diabetes,” she
said. “The authors of this study do endorse this as a possible
explanation for their findings.”
These results only pertain to type 1 diabetes, the less common form
of the disease that typically begins in childhood and must be
controlled with administered insulin, researchers caution. Type 2
diabetes, most frequently diagnosed in middle adulthood, is much
more common, and has different underlying causes. In addition,
gestational diabetes is a separate condition that occurs during
pregnancy and usually disappears after the baby is born.
“I don't know of any study of this type that was done with women who
had gestational or type 2 diabetes,” said Dr. Jorge H Mestman,
director of the University of Southern California Center for
Diabetes and Metabolic Disease in Los Angeles. “So we can’t apply
these results to other types of diabetes.”
Overall, the study is very provocative and the results are exciting,
Mestman noted, “but it needs to be repeated.”
Mothers with very poor blood sugar control may have had other
complications, and that would need to be accounted for, he added.
SOURCE: http://bit.ly/1BHN5sv Diabetes Care, online June 12, 2015.
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