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Effects on Neurocognitive Development and Risk of Attention-Deficit/Hyperactivity Disorder in Offspring

Yoko Nomura, PhD, MPH; David J. Marks, PhD; Bella Grossman, MA; Michelle Yoon, BS, BA; Holly Loudon, MD, MPH; Joanne Stone, MD; Jeffrey M. Halperin, PhD

Arch Pediatr Adolesc Med. Published online January 2, 2012. doi:10.1001/archpediatrics.2011.784

Objective  To examine the independent and synergistic effects of gestational diabetes mellitus (GDM) and low socioeconomic status (SES) on neurodevelopment and attention-deficit/hyperactivity disorder (ADHD) outcomes.

Design  Cohort study.

Setting  Flushing, New York.

Participants  A total of 212 preschool children as a part of the ongoing cohort study.

Main Exposures  Gestational diabetes mellitus and low SES.

Main Outcome Measures  Primary outcomes are ADHD diagnosis based on Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) criteria at age 6 years and several well-validated measures of neurobehavioral outcomes, cognitive functioning, ADHD symptoms, and temperament at age 4 years. Secondary outcomes are parent and teacher reports of behavioral and emotional problems at age 6 years. Neurobehavioral measures in relation to GDM and low SES were examined using generalized estimating equations and multivariate logistic regression analyses.

Results  Both maternal GDM and low SES were associated with an approximately 2-fold increased risk for ADHD at age 6 years. However, the risk by GDM was greater among lower SES families than among higher SES families. Children exposed to both GDM and low SES demonstrated compromised neurobehavioral functioning, including lower IQ, poorer language, and impoverished behavioral and emotional functioning. A test of additive interaction found that the risk for ADHD increased over 14-fold (P = .006) when children were exposed to both GDM and low SES. Neither children exposed to maternal GDM alone nor those exposed to low SES alone had a notable increased risk for ADHD.

Conclusions  Maternal GDM and low SES, especially in combination, heighten the risk for childhood ADHD. Long-term prevention efforts should be directed at mothers with GDM to avoid suboptimal neurobehavioral development and mitigate the risk for ADHD among their offspring.

Author Affiliations: Department of Psychology, Queens College, City University of New York, Flushing, New York (Drs Nomura and Halperin); Departments of Psychiatry, Division of Child and Adolescent Psychiatry, (Drs Nomura, Marks, and Halperin and Ms Yoon), and Obstetric, Gynecology, and Reproductive Science (Drs Loudon and Stone), Mount Sinai School of Medicine, New York, New York; and Department of Psychology, New School, New York (Ms Grossman).

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