Diabetes in pregnancy and school-age developmental outcomes for offspring: A statewide retrospective cohort study

Objective: The impact of diabetes in pregnancy on offspring neurodevelopment is unclear. We investigate whether exposure to diabetes in-utero is associated with developmental vulnerability or educational delay during primary school. Research Designs and Methods: We used population-level pregnancy and birth data from 2009-2021 from Victoria, Australia, linked with standardised national assessments. Adjusting for a range of maternal and childhood covariates, we investigated whether diabetes in pregnancy was associated with an altered risk of developmental vulnerability compared with no diabetes in the first year of fulltime school (ages 4-6 years), defined as <10th centile in two or more domains in the Australian Early Development Census (AEDC), and altered educational outcomes in grade three (ages 7-8 years), defined as the adjusted mean difference in overall z-score in the National Assessment Program – Literacy and Numeracy test (NAPLAN). Results: 177,898 children had linked birth and AEDC data and 115,231 with linked birth and NAPLAN data, including 16,363 (9.2%) and 7,532 (6.5%) exposed to diabetes in pregnancy respectively. Following adjusted analysis, diabetes in pregnancy was not associated with an altered risk of overall developmental vulnerability compared with no diabetes (adjusted relative risk (aRR) 1.02 [95% confidence interval (CI) 0.98-1.07]). Diabetes was associated with a marginally higher overall NAPLAN z-score, but below the prespecified threshold for clinical significance (adjusted mean difference 0.04 [95%CI: 0.01-0.07]). Conclusions: Diabetes in pregnancy was not associated with overall developmental vulnerability nor a clinically meaningful difference in educational outcomes. This should provide reassurance for patients and their treating clinicians.