The study, published this
week in the Archives of Pediatrics and Adolescent Medicine, found that
children whose mothers received a diabetes diagnosis during pregnancy
(known as gestational diabetes) were twice as likely as their peers to
meet the criteria for attention deficit hyperactivity disorder (ADHD) at
age six.
Living in a family with
below-average socioeconomic status likewise doubled the risk of ADHD in
six-year-olds. But children with both risk factors -- those who were
exposed to gestational diabetes and grew up in a less-than-affluent
household -- had a 14-fold increased risk of ADHD compared to children
with neither risk factor.
The findings don't prove
that gestational diabetes directly causes ADHD, but the researchers say
they send a message to mothers and doctors that gestational diabetes may
pose hidden dangers to a child well after birth, especially if the
child grows up in a challenging environment.
"Mothers should be aware
that gestational diabetes can affect her fetus," says Yoko Nomura,
Ph.D., the lead author of the study and an assistant clinical professor
of psychiatry at the Mount Sinai School of Medicine, in New York City.
Gestational diabetes,
which affects roughly 5% of expectant mothers in the United States,
generally develops during the second or third trimester of pregnancy --
the same window of time in which a fetus undergoes a critical burst of
brain development.
Women with gestational
diabetes have abnormally high blood sugar (glucose). If the fetus is
bombarded with excess blood sugar, energy normally used for
nervous-system development could potentially be diverted to absorb that
excess, Nomura says. As a result, the central nervous system may not
develop properly.
Growing up in poverty would likely aggravate any underlying nervous-system deficits, Nomura says.
"When babies are born
into higher socioeconomic status households, they have better access to
medical care [and] remedial activities, intellectual stimulus is higher,
they have better foods," she says.
In addition, low-income
women may not control their gestational diabetes as well as more
prosperous mothers-to-be, says Luigi Garibaldi, M.D., clinical director
of pediatric endocrinology at the Children's Hospital of Pittsburgh.
"Having diabetes during
pregnancy by itself may not be so bad, but if you don't take care of it,
there may be consequences on the brain development of the child," says
Garibaldi, who was not involved in the study.
Nomura and her
colleagues followed 212 ethnically and socioeconomically diverse
children living in Queens, New York, 10% of whom were exposed to
gestational diabetes. From preschool through age six, a trained
psychologist or doctoral student evaluated each child for ADHD symptoms
annually.
The study had several
shortcomings. It was relatively small, and although they did take into
account the parents' history of ADHD, the researchers didn't collect
data on whether the children had siblings or other relatives with
attention or hyperactivity problems. Also, Garibaldi notes, the
researchers didn't measure how well the mothers controlled their
gestational diabetes.
Still, the study is a
valuable reminder that a child's environment -- in and out of the womb
-- appears to affect the risk of ADHD, says Joel Nigg, Ph.D., a
professor of psychiatry at Oregon Health & Science University, in
Portland.
Previous research
suggests, for instance, that children are at increased risk of ADHD if
they're exposed to lead and certain pesticides.
"As a precaution, we
might want to add [gestational diabetes] to the list of risk factors
we're aware of," says Nigg, who wrote an editorial accompanying the
study.
Source : http://www.cnn.com
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