Growth and neurodevelopment of children born to diabetic mothers and to mothers with gestational diabetes

Introduction It is well known that diabetes during pregnancy may be associated with an increased rate of spontaneous abortions, intrauterine death and congenital anomalies among the offspring.1-5 This increase is directly related to the severity of the disease, especially to the blood levels of glycosylated hemoglobin (HbA1c).3,4,6 The reduction in the prevalence of congenital anomalies among offspring of mothers with pre-gestational diabetes (PGD) observed in the last years is related to the marked improvement of glycemic control in early pregnancy. However, even in well-treated diabetic pregnant women, the rate of congenital anomalies is still significantly higher than in the general population. Generally, no increase in congenital anomalies was observed among children born to mothers with gestational diabetes (GD).3,5 However, more recent reports have shown that children born to mothers with GD with fasting hyperglycemia or with increased pre-gestational maternal obesity or increased body mass index (BMI), have an increased rate of congenital anomalies, especially of the CNS and are prone to develop at childhood the metabolic syndrome X.6,7 It is also proposed that the studies demonstrating increased rate of congenital anomalies in offspring of women with GD also include women whose diabetes was first diagnosed in pregnancy, but apparently started before gestation.