Long-term developmental follow-up of infants of diabetic mothers,☆☆,,★★

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Abstract

The neurodevelopmental consequences of maternal insulin-dependent diabetes were studied in 109 infants of diabetic mothers and 90 control infants. The infants born to diabetic mothers included 70 "early entry" subjects and 39 "late entry" subjects. Maternal diabetes control during pregnancy was significantly better in "early entry" mothers than in late-entry mothers, as determined by glycosylated hemoglobin levels. Infants were examined by a psychologist and a developmental pediatrician unaware of group status at 6, 12, 24, and 36 months of age; 71% of the subjects completed the 3-year study. Neurodevelopment of early-entry subjects was similar to that of control subjects, whereas late-entry subjects scored less well on language measures. Mean head size in late-entry subjects was significantly less (p = 0.03) than in either control subjects or early-entry subjects at age 3 years, and correlated negatively with glycosylated hemoglobin levels during all three trimesters. Less optimal intellectual development was associated with reduced head circumference. In addition, the presence of major congenital malformations was associated with reduced developmental performance through age 2 years. Our results indicate that mothers with insulin-dependent diabetes who maintain good control during pregnancy can expect to have infants who are neurodevelopmentally normal; mothers whose diabetes is less well controlled may have infants with less optimal neurodevelopment. (J PEDIATR 1994;125:S9-17)

Section snippets

METHODS

Our study was conducted to complement the University of Washington's component of the multicenter collaborative Diabetes in Early Pregnancy project, a study funded and coordinated by the National Institute of Child Health and Human Development. The DIEP project was designed to quantify the risk of malformations in offspring of insulin-dependent diabetic mothers and to identify the factor or factors associated with the increased risk associated with pregnancies of diabetic women. The original

Maternal characteristics

Although the mothers had not necessarily planned to participate in a follow-up study at the time of enrollment in the original DIEP study, 71% of the families who agreed to participate in the follow-up continued their involvement through the completion of our 3-year study. Among diabetic mothers, but not control mothers, those with more education were less likely to leave the study prematurely.

Our study and control populations were primarily white, married, of middle income, and well educated.

DISCUSSION

The purpose of this study was to determine whether maternal insulin-dependent diabetes results in impaired neurodevelopment in childhood. Previous studies2, 7 have suggested that infants born to insulin-dependent diabetic mothers are at risk of having neurodevelopmental sequelae. In conducting this study, the majority of infants were followed for a 3-year period and the characteristics of the pregnant diabetic women and their newborn infants were similar to those from the larger, five-center

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  • Cited by (0)

    From the Departments of Pediatrics, Psychiatry and Behavioral Sciences, Obstetrics and Gynecology, and Medicine, the Child Development and Mental Retardation Center, University of Washington, Seattle, and the Child Development and Rehabilitation Center, Oregon Health Sciences University, Portland

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    Supported by National Institute of Child Health and Human Development grant No. 1R01 HD17212-01A1, by March of Dimes Birth Defects Foundation grant No. 12-81, and by the Clinical Nutrition Research Unit (CNRU) (University of Washington, Seattle) grant No. DK-35816.

    Reprint requests: Clifford J. Sells, MD, MPH, Child Development and Rehabilitation Center, PO Box 574, Portland, OR 97207-0574.

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