Researchers have long investigated whether conditions during pregnancy might influence the likelihood of children developing autism spectrum disorder (ASD). One condition that has drawn increasing attention is gestational diabetes mellitus (GDM), which has become more common worldwide.
In a recent population-based study published in Frontiers of Clinical Diabetes and Healthcare, David Rubinshtein, of the Ben-Gurion University of the Negev in Beer-Sheva, Israel, and colleagues assessed whether this pregnancy complication is associated with a higher risk for autism in children.
Gestational diabetes occurs when hormonal changes during pregnancy affect the body’s ability to regulate blood sugar. Although it usually resolves after delivery, it can still affect both maternal and fetal health. Because the condition influences metabolism and the intrauterine environment, scientists have explored whether it might also affect early brain development.
To investigate this question, the researchers conducted a large retrospective cohort study using medical records from a tertiary hospital and its affiliated community clinics. The study included records of more than 115,000 deliveries, making it one of the larger analyses of the potential connection between gestational diabetes and autism risk.
Pregnancies were classified into three groups according to presence or absence of GDM and treatment provided. The researchers described the groups as “diet-controlled GDM (GDM A1), medication-treated GDM (GDM A2), and pregnancies without GDM, which served as the reference group.”
Children born from these pregnancies were followed up over time by means of centralized hospital and outpatient medical records. Diagnoses of ASD were made by qualified specialists using the criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition.
Of the 115,063 births included in the study, approximately 3% of pregnancies involved diet-controlled GDM and 1% involved medication-treated GDM. During childhood follow-up, 767 children were diagnosed with autism.
Initial statistical analysis suggested a possible pattern: autism diagnoses were slightly more common among children whose mothers had gestational diabetes. The incidence of autism was 1.5% in the medication-treated group, 1.0% in the diet-controlled group, and 0.6% in the group of pregnancies without GDM. These differences appeared statistically significant in preliminary comparisons.
However, the researchers conducted additional analyses to account for other factors that might influence autism risk. These factors included maternal characteristics (eg, age, ethnicity, obesity, smoking), pregnancy conditions, and other variables that could affect outcomes.
After adjusting for these potential confounding factors using a multivariable statistical model, the association between GDM and ASD was no longer statistically significant.
The researchers concluded that although GDM showed a higher raw incidence of autism in initial comparisons, the relationship likely reflects the influence of other related factors rather than a direct causal link.
These findings contribute to an ongoing scientific debate. Previous studies have produced mixed results, with some suggesting a possible connection between maternal metabolic conditions and neurodevelopmental outcomes, whereas others have shown little or no independent association.
“Our findings indicate that GDM and its subtypes, despite their known associations with obstetric and neonatal complications, do not appear to increase the long-term risk of ASD in offspring after full adjustment,” the researchers wrote.
“However, it remains possible that early-onset or poorly controlled GDM may exert subtle effects on fetal neurodevelopment that are not detectable in our regional cohort, despite comprehensive and centralized healthcare coverage,” they continued.
They noted that further research is needed to clarify how maternal health conditions, metabolic factors, and the prenatal environment might interact with genetic influences in shaping neurodevelopment. Understanding these relationships could help improve prenatal care and identify early risk factors that influence childhood development.