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DALLAS -- Brain changes were seen in kids exposed to gestational diabetes in utero, which may contribute to an increased risk of obesity, according to a cross-sectional study of data from the Adolescent Brain Cognitive Development (ABCD) study.

Compared with children not exposed, 9- and 10-year-olds with prenatal exposure to gestational diabetes had significantly smaller total cortical gray matter volume after false discovery rate correction (β = -0.051, 95% CI -0.089 to -0.013, P=0.045), reported Shan Luo, PhD, of the Keck School of Medicine at the University of Southern California in Los Angeles, during the ObesityWeek annual meeting.

In addition, there was an association between gestational diabetes exposure and adiposity markers -- 42% of exposed kids had overweight or obesity compared with 29% of unexposed kids. They also had significantly higher body mass index (BMI) z scores, waist circumference, and weight-to-height ratio, though global cortical gray matter volume partially mediated these relationships, according to the study, which was simultaneously published in the journal .

"We think that the results identified robust brain signatures associated with gestational diabetes exposure in a large and diverse sample and suggested that low cortical gray matter volume may be a neural, biological mechanism explaining obesity in gestational diabetes-exposed offspring," Luo said. "I think the detrimental effects of diabetes during pregnancy on the developing brain in offspring should be noted for clinicians."

Associations between prenatal exposure to gestational diabetes and brain changes held true when the sample of children was whittled down to only sibling pairs, with significantly smaller gray matter volume seen in exposed siblings compared with unexposed siblings (β = -0.284, 95% CI -0.531 to -0.037, P=0.034).

More specifically, exposed children had smaller cortical gray matter volume in the bilateral rostral middle frontal gyrus (β = -0.087, 95% CI -0.143 to -0.031, P=0.042) and superior temporal gyrus (β = -0.098, 95% CI -0.154 to -0.043, P=0.017).

"Results for global and regional cortical gray matter volume remained largely the same after additional adjustment for gestational age, other maternal health problems during pregnancy, child health problems at birth, or maternal alcohol/tobacco use during pregnancy," the authors wrote.

As for potential mechanisms behind this link, Luo said that hyperglycemia, dyslipidemia, and inflammation from gestational diabetes could be the driving forces for these brain changes.

She noted that the didn't include data on diabetes management during pregnancy or when in pregnancy gestational diabetes was diagnosed. But noting some other potential moderators of these associations, she suggested that where the family lived may have played a role in the child's brain development.

"I think potentially the children that grew up in disadvantaged neighborhoods would show stronger negative effects of exposure on some of the brain measures," she said.

This study included 8,521 children, 7% of whom were exposed to gestational diabetes. Mean age was 9.9, 51.4% were boys, 56.2% were white, 19.3% were Hispanic, and 12.5% were Black.

Brain structure was measured by MRI, and gestational diabetes exposure was self-reported.

There were no significant links between prenatal gestational diabetes exposure with gray matter volume in any subcortical regions, cortical surface area, mean cortical thickness, nor cerebral white matter volume.

"Future intervention studies can look at some things that could mitigate adverse effects of prenatal gestational diabetes exposure on offspring brain development, thereby reducing obesity risk," Luo suggested.

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