584 - Gestational Diabetes Mellitus and School-Age Cognitive and Health Outcomes: a Matched Cohort Study

Publication Number: 584.5201

Jane M. Alsweiler, School of Medicine, University of Auckland, Auckland, Auckland, New Zealand; Francesca Amitrano, University of Auckland, Auckland, Auckland, New Zealand; Jane E. Harding, Liggins Institute, University of Auckland, Auckland, New Zealand, Auckland, Auckland, New Zealand; Caroline A. Crowther, University of Auckland, Auckland, Auckland, New Zealand; Gavin T. L.. Brown, university of Auckland, Auckland, Auckland, New Zealand; Christopher McKinlay, University of Auckland, Auckland, Auckland, New Zealand

Background: Gestational diabetes (GDM) is common, but the cognitive and health outcomes of children born to women with GDM are uncertain due to the high prevalence of potential confounders, such as maternal obesity, lower socioeconomic status and preterm birth, which may not have been adequately accounted for in previous studies.

Objective: To determine if children exposed in utero to GDM have poorer school-age neurocognitive and cardiometabolic function than matched children not exposed to GDM.

Design/Methods: Matched cohort study. Children of women diagnosed with GDM (fasting glucose ≥5.5 mmol/L [≥99 mg/dL] or 2-hour value ≥9.0 mmol/L [≥162 mg/dL] on a two-hour 75g oral glucose tolerance test) from the pre-hPOD Study were matched for sex, maternal body mass index (BMI), ethnicity, socio-economic status and gestational age to children born at the same hospital whose mothers did not have GDM. GDM-exposed and nonGDM-exposed children were assessed at 6-7 years’ corrected age for neurocognitive function (NIH Toolbox), numeracy (Checkout Game), academic achievement, body composition, peripheral/central blood pressure and grip strength. The primary outcome was the Composite Cognitive Standard Score. Analysis was by generalized linear models, adjusted for matching criteria; exposure effects were estimated as odds ratio(OR) or mean difference(MD), with 95% confidence intervals(CI).

Results: 372 children were assessed (186 GDM-exposed, 186 nonGDM-exposed). Exposure groups were similar for mean[SD] birthweight z-score (0.06[0.98] v 0.01[0.94]), corrected age at assessment (6.8[0.4] v 6.8[0.4] years), matching criteria and hypertensive disorders of pregnancy (12.3% v 12.9%). There was no difference between groups in mean[SD] cognitive score (104[15] v 104[15]; MD=2[-2,5]) or its components. GDM-exposed children were less likely to have motor impairment (6% v 11%, OR=0.43[ 0.19,0.96] but more likely to have low numeracy (10% v 4%, OR=3.75[1.35,10.42]) and hypertension (14% v 6%, OR=2.45[1.13,5.27]), and had higher mean[SD] BMI z-scores (0.95[1.61] v 0.51[1.50], MD=0.39[0.13,0.65]). GDM-exposed children had higher mean[SD] whole-body lean mass (22.4[5.6] v 20.9[4.9] kg, MD=1.2[0.3,2.1]), but not whole-body fat mass (5.7[4.3] v 5.0[3.2] kg, MD=0.4[-0.3,1.0]), and were similar for measures of muscle mass (arm-muscle area and grip strength).

Conclusion(s): Children exposed to GDM are not at increased risk of poorer school-age cognitive function compared to controls matched for potential confounders. However, GDM exposure was associated with increased childhood BMI and blood pressure, which may affect subsequent cardiometabolic health.