Maternal Diabetes and Attention Deficit/Hyperactivity Disorder Association: A Narrative Review on Emerging Evidence, Research Gaps and Future Directions

Maternal diabetes includes pre-gestational diabetes mellitus (PGDM) and gestational diabetes mellitus (GDM), with increasing prevalence globally. Attention Deficit Hyperactivity Disorder (ADHD) is a common childhood neurodevelopmental disorder. This narrative review synthesizes epidemiological and mechanistic evidence published mainly since 2023 to explore the association between maternal diabetes and ADHD in offspring. Pooled data show that maternal diabetes increases offspring ADHD risk by approximately 30%, with PGDM showing a stronger association than GDM, and poorly controlled diabetes or diabetes requiring medication conferring higher risk. Mechanistically, intrauterine hyperglycemia induces oxidative stress, inflammatory responses, placental dysfunction, neurotransmitter imbalance, and epigenetic alterations, which may impair fetal neurodevelopment. Inconsistencies remain in diabetes classification, diagnostic criteria, glycemic control level, and offspring assessment age. Most existing studies are observational and cannot confirm causality. This review identifies research limitations and provides a theoretical basis for prenatal glucose management and early intervention. These findings have important public health implications for reducing the burden of neurodevelopmental disorders.