| Objective To examine the influence of gestational diabetes mellitus(GDM) on offspring’s developmental behaviors at 6 months of life and analyses the roles of individual and social factors in GDM and infants’ development.Methods This study is part of Ma’anshan Birth Cohort(MABC). We recruited pregnant women who were less than 14 weeks with informed consent in Ma’anshan Maternal and Child Care Center in May 2013 to September 2014. They all filled in the maternal records in pregnancy, including the baseline information of pregnant women and her husband, family history of chronic diseases. Women finished the 75 gram oral glucose tolerance test(OGTT) between 24 weeks and 28 weeks and we recorded the fasting plasma glucose values and plasma glucose values after 1 hour and 2 hour. Besides, we recorded the neonate’ information, including birth weight, head circumference, height, gestational age. Caregivers would take the 6 month infants to the Ma’anshan Maternal and Child Care Center to take a physical examination and finish the ages and stages questionnaires. Descriptive statistics were mean and standard deviation for normal variables, median and interquartile range for non-normal ones, and absolute frequencies and percentages for those categorical. Comparisons of continuous variables were conducted using analysis of variance(t test) and Chi-Square test was applied to test groupdifferences between categorical variables. Binary logistic regression model and nonparametric rank-sum test(Mann-Whitney U test) were used to analyses the effect of GDM on 6 month infants’ development. P<0.05 was perceived as statistically significant.Results A total of 3 474 eligible women were recruited and 2 753 women were in this study, which 366(13.3%) were exposed to GDM and 2 387 were without GDM. The prevalence of delayed development of communication, gross motor, fine motor, problem solving, and personal-social were 31.1%, 27.2%, 27.6%, 32.4% and 28.7%, respectively. Compared with control group, the women in GDM group were older [(27.51±4.09) years vs.(26.00±3.41) years, P<0.001], had higher mean BMI in prepregnancy [(22.21±3.20) kg/m2 vs.(20.68±2.73) kg/m2, P<0.001], and younger menophania age [(13.74±1.38) years vs.(13.94±1.33) years, P=0.006]. Besides, they had higher proportion of multipara(14.5% vs. 10.1%,P=0.011), cesarean section(60.9% vs. 49.4%, P<0.001), urban resident(70.2% vs. 61.7%, P=0.002) and family monthly income per capita less than 2500 yuan(31.7% vs. 25.3%, P=0.012). Compared with control group, the neonate in GDM group had lower birth weight [(3 476.67±541.36) g vs.(3355.77±420.79) g, P<0.001], less gestational age [(273.05±11.38) days vs.(276.75±8.77) days, P<0.001], less head circumference [(34.29±1.05) cm vs.(34.03±1.59) cm, P=0.006] and chest circumference [(33.78±1.68) cm vs.(33.47±1.49) cm, P=0.001]. In ASQ comparison, the two groups showed no significant difference in developmental performance score(P> 0.05). The scores of 6 months infants of GDM mother had no significant difference with the control group, after adjusted for maternal age, gestational weight gain, gestationalage, neonatal head circumference, neonatal chest circumference, height and subcutaneous fat thickness at 6 month. The difference were not significant after adjusted for family monthly income per capita, education level of parents and feeding patterns at 6 month, neither(P> 0.05). Infants who had delayed development had higher FPG value in early pregnancy in gross motor(MD=0.04, 95%CI: 0.01~0.08, P=0.012), fine motor(MD=0.05, 95%CI: 0.02~0.08, P=0.005) and personal-social(MD=0.06, 95%CI: 0.03~0.09, P=0.001), but lower FPG value in late pregnancy in gross motor(MD=-0.09, 95%CI:-0.15~-0.04, P=0.001), fine motor(MD=-0.07, 95%CI:-0.13~0.02, P=0.006), problem solving(MD=-0.09, 95%CI:-0.14~0.04, P=0.001) and personal-social(MD=-0.15, 95%CI:-0.21~-0.10, P<0.001).Conclusion The GDM had no significant effect on 6 month infants. There maybe a critical period in utero that influence fetal development. It’s possible that there’s no harm of delayed development or apparent delayed development from GDM. We suggested more studies examine school-age children or adolescents to further evaluate the executive function and so on. |
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