Mental Health
Association between Gestational Diabetes Mellitus and Child Mental Disorders: Population-based Target Trial Emulation in Taiwan Chin-Kuo Chang* Chin-Kuo Chang Pei-Chun Chen
Background Gestational diabetes mellitus (GDM) prevalence has been increasing globally, and maternal hyperglycemia is known as a risk factor for adverse birth outcomes, but limited to offspring’s mental health in later life.
Methods The National Health Insurance Database (NHID) is a data source of the universal health insurance system in Taiwan, with a high population coverage. We constructed a population-based birth cohort by linking mothers’ health records to their offspring to evaluate the effect of GDM during pregnancy on child mental disorders detected in follow-up defined by ICD-9 and ICD-10 codes, focusing on externalizing disorders and neurodevelopmental disorders. Kaplan-Meier curves and Cox proportional hazard models were applied to estimate the hazard ratio of GDM for their offspring’s mental disorders. To enhance comparability between exposure groups, a series of statistical attempts were carried out in models, including full confounding adjustment, propensity score, and inverse probability of treatment weighting, to emulate a hypothetical randomized trial.
Results From 2005 to 2017, NHID recorded more than 2.44 million pregnancies as the basis of assembling a population-based birth cohort by a linkage to the mothers’ offspring, excluding the ones who were not the first single birth of a mother, whose mothers had a diagnosis of either type of diabetes before pregnancy or on antidiabetics, and stillbirths. A total of eligible 1,399,039 children were followed up for up to 13 years for analyses, with a mean age of 30.06 (SD=4.94) years old for mothers, and 91,351 of them were diagnosed with GDM during pregnancy. Significantly elevated risks were identified for a wide range of child mental disorders, especially for attachment disorder (adj.HR=1.25; 95% CI: 1.04, 1.51), followed by Asperger’s syndrome (adj.HR=1.22; 95% CI: 1.09, 1.36). Similar outcomes were found in sensitivity analyses showing robustness.
Conclusion GDM during pregnancy is significantly associated with increased risks of various mental disorders in offspring, particularly attachment disorder and Asperger’s syndrome, with confounding fully considered.