A global team of researchers has conducted a 20-year study to investigate the potential link between maternal diabetes and attention-deficit/hyperactivity disorder (ADHD) in children. The study analyzed data from over 3.6 million mother-baby pairs in several countries, including China’s Hong Kong, Taiwan, New Zealand, Finland, Iceland, Norway, and Sweden. The findings suggest that maternal diabetes during pregnancy is not likely to directly cause ADHD. The study was led by Professor Ian Wong Chi-kei, Head of the Department of Pharmacology and Pharmacy.The pharmacy at LKS Faculty of Medicine of the University of Hong Kong (HKUMed) has conducted a 20-year longitudinal study to address the debate about the potential impact of maternal diabetes on attention-deficit/hyperactivity disorder (ADHD) in children. This study analyzed real-world data from over 3.6 million mother-baby pairs in China’s Hong Kong, Taiwan, New Zealand, Finland, Iceland, Norway, and Sweden, and found that maternal diabetes during pregnancy is unlikely to directly cause ADHD. The findings of this study were published in Nature Medicine on 8 April.
Context
Worldwide, around 16% of women experience high blood sugar levels while pregnant, and the occurrence of diabetes during pregnancy has been increasing due to factors like being overweight and having a child at an older age. This can have a detrimental impact on the baby’s brain and nervous system development. ADHD is among the most prevalent neurodevelopmental disorders in children, and it can lead to serious negative outcomes. People with ADHD are at risk for issues such as emotional problems, self-harm, substance abuse, academic struggles, being expelled from school, and difficulties finding work.
and relationships, and even criminality.
There has been ongoing debate about the impact of maternal diabetes on the risk of ADHD in children due to inconsistent findings in previous studies. This has raised concerns about pregnancies in women with diabetes and their potential connection to the risk of ADHD in children. Recognizing the importance of identifying risk factors for ADHD, especially for women of childbearing age, a cross-regional study funded by the Hong Kong Research Grants Council used population-based data from China’s Hong Kong, Taiwan, New Zealand, Finland, Iceland, Norway and Sweden to comprehensively analyze the issue.This article aims to examine the link between maternal diabetes and the likelihood of ADHD in children. The research methods and findings of the study are as follows:
The study included a large sample size of over 3.6 million mother-child pairs from the years 2001 to 2014, with follow-up continuing until 2020. The researchers made significant observations about the connection between maternal diabetes during pregnancy and the risk of ADHD. The study revealed that children born to mothers with any form of diabetes, whether it was before or during pregnancy, had a slightly higher risk of developing ADHD compared to children who were not exposed, with a hazard ratio of 1.16. The study’s findings are crucial in understanding the impact of maternal diabetes on the likelihood of ADHD in offspring.There were higher chances of ADHD for both gestational diabetes (diabetes during pregnancy) and pregestational diabetes (diabetes before pregnancy). The hazard ratio for gestational diabetes was 1.10, showing a slightly increased risk. On the other hand, the hazard ratio for pregestational diabetes was 1.39, indicating a more significant association.
Surprisingly, when the research team compared the risk of ADHD between siblings with different exposure to gestational diabetes, they found no significant difference. This unexpected result suggests that the previously identified risk of ADHD when children were exposed to gestational diabetes may not be as significant.gestational diabetes during pregnancy is more likely caused by shared genetic and familial factors, rather than solely gestational diabetes. These findings contradict previous research that suggested maternal diabetes during or before pregnancy could increase the risk of ADHD in children.
Research significance
Professor Ian Wong Chi-kei, Lo Shiu Kwan Kan Po Ling Professor in Pharmacy, and Head of the Department of Pharmacology and Pharmacy at HKUMed, stated that collaborating with renowned scholars from around the world to analyze cross-regional cases spanning over 20 years was a significant aspect of the research.The task was quite challenging. The team worked together to gain a thorough understanding of the topic.
‘Unlike previous research that suggested a strong link between maternal diabetes during pregnancy and the risk of ADHD, our study discovered only a slight connection between maternal diabetes and ADHD in children. This was after taking into account the complex interaction of different influential factors. It’s important to note that comparisons between siblings indicated that this association is probably affected by shared genetic and familial factors, especially in the case of gestational diabetes,’ Professor Wong explained.
He emphasized the importance of further research and understanding in this area.The study emphasizes the importance of thoughtful consideration and further investigation. It suggests that women planning pregnancy should take into account their overall risk profile rather than just focusing on gestational diabetes. The future research should explore the specific roles of genetic factors and proper blood sugar control during different stages of embryonic brain development in humans.
The research team was co-led by Professor Ian Wong Chi-kei, Lo Shiu Kwan Kan Po Ling Professor in Pharmacy, and Head of the Department of Pharmacology and Pharmacy at HKUMed, along with Dr. Kenneth Man.Keng-cheung, Honorary Assistant Professor at HKUMed and Lecturer at University College London; Dr Carolyn Cesta, Assistant Professor at Karolinska Institute, Sweden; Professor Edward Lai Chia-cheng, National Cheng Kung University, Taiwan; Professor Helga Zoega, Associate Professor at UNSW Sydney, Australia. The primary authors were Dr Adrienne Chan Yu-ling, Senior Research Assistant, and Dr Gao Le, Postdoctoral Fellow, at the Department of Pharmacology and Pharmacy.cy, HKUMed; Dr Miyuki Hsieh Hsing-chun, School of Pharmacy, National Cheng Kung University, Taiwan; and Dr Lars Kjerpeseth, Department of Chronic Diseases, Norwegian Institute of Public Health.
Other members in the research team included experts in child psychiatry and epidemiology such as Dr Raquel Avelar, Professor Tobias Banaschewski, Dr Amy Chan Hai-yan, Professor David Coghill, Dr Jacqueline M Cohen, Dr Mika Gissler, Professor Jeff Harrison, Professor Patrick Ip Pak-keung, Clinical Professor, Department of Paediatrics and Adolescent Medicine, School of Clinical Medicine, HKUMed, Dr Øystein Karlstad, and Dr Wallis CY Lau, HonoraryThe following individuals were involved in the research project: Research Associate, Department of Pharmacology and Pharmacy, HKUMed; Dr Maarit K Leinonen; Dr Leung Wing-cheong; Liao Tzu-chi; Dr Johan Reutfors; Dr Shao Shih-chieh; Professor Emily Simonoff; Professor Kathryn Tan Choon-beng, Department of Medicine, School of Clinical Medicine, HKUMed; Professor Katja Taxis; and Andrew Tomlin.
Acknowledgements
Funding for this work was provided by the General Research Fund of the Hong Kong Research Grants Council.
Journal Reference:
- Adrienne Y. L. Chan, Le Gao, Miyuki Hsing-Chun Hsieh, Lars J. Kjerpeseth, Raquel Avelar, Tob rnrnias Banaschewski, Amy Hai Yan Chan, David Coghill, Jacqueline M. Cohen, Mika Gissler, Jeff Harrison, Patrick Ip, Øystein Karlstad, Wallis C. Y. Lau, Maarit K. Leinonen, Wing Cheong Leung, Tzu-Chi Liao, Johan Reutfors, Shih-Chieh Shao, Emily Simonoff, Kathryn Choon Beng Tan, Katja Taxis, Andrew Tomlin, Carolyn E. Cesta, Edward Chia-Cheng Lai, Helga Zoega, Kenneth K. C. Man, Ian C. K. Wong. “Maternal diabetes and risk of attention-deficit/hyperactivity disorder in offspring in a multinational cohort of 3.6 million mother–child pairs”. Nature Medicine, 2024; DOI: <a href=”http://dx.doi.org/10.1038/s41591-024-02917-8” sHere is the HTML code for the article:
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