Introduction:
Gestational diabetes has been on the rise in recent years. It is associated with neurodevelopmental disorders. Children born to these women tend to suffer from neurobehavioral problems. Autism spectrum disorder (ASD) is a neurodevelopmental and behavioral disorder that affects social interaction and communication.
What Is Autism?
Autism, otherwise called ASD, involves various conditions that are related to the development of the brain. One in a hundred children suffers from autism. They exhibit difficulty in social interaction and communication with others. Other behaviors include difficulties transitioning from one activity to another, focusing on details, and unusual reactions to sensations.
The abilities and needs may vary from one to another. Some with autism may not be dependent, whereas others may need support for their whole life. This condition may affect education and employment aspects.
The characteristics may be found in early childhood, but autism is not detected until late. Autism is linked to many other conditions, such as depression, epilepsy, anxiety, sleeping difficulty, self-injury, and attention deficit hyperactivity disorder. It was found that intellectual functioning may vary from one person to another.
Environmental and genetic factors are thought to cause autism. Women during pregnancy, if found to have diabetes or obesity, and if exposed to certain medications, may have children with autism. It was found that childhood vaccines do not have a higher risk for autism.
Symptoms of autism include,
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These lack eye contact.
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Less interest or intense interest in a few topics.
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Repetitive behaviors can be observed.
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Sensitive to sounds, touch, and smells that are ordinary to others.
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These neither look at others nor listen.
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They do not feel like being held or cuddled.
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Face problems using speech, gestures, facial expressions, and tone of voice.
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Need help in adjusting to changes in daily routines.
What Is Gestational Diabetes?
Gestational diabetes (GD) can occur only among pregnant women. Diabetes is a condition in which high blood glucose levels can be observed. It usually occurs during pregnancy, between 24 to 28 weeks. 2-10 % of pregnant women in the U.S. (United States) are affected.
Hormonal changes and the way the body converts food to energy are the causative factors for GD. Insulin is responsible for the regulation of blood glucose levels. If the insulin levels are insufficient or do not work the way it should, it may lead to a buildup of glucose levels in the blood.
GD may develop in any pregnant woman. The risk of GD may be increased among those with
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Heart disease.
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Those who are inactive.
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Obese women.
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Those with a personal or family history of GD.
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Polycystic Ovarian Syndrome.
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Prediabetic condition.
Symptoms of GD include,
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The frequency of urination increases.
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Feel nausea.
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Increased thirst.
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Feel fatigue.
What Is the Link Between Gestational Diabetes and Autism?
Researchers have found that women with GD have a higher risk of having a child with autism when compared with those without GD. A study done in 2018 suggested that maternal diabetes, either type 1 or type 2 diabetes or GD, are found to have an increased risk for ASD among their offspring. A study done among pregnant women showed that those children born to have glycated hemoglobin (HbA1C) at 6.5 % and above had twice the risk of getting affected by ASD in the first 4 years of life when compared to those mothers with HbA1C below 5.7 %.
A study done in 2018 showed that the severity of GD is linked to the risk of a child getting affected by ADHD (attention deficit hyperactivity disorder). It was found that type 1 diabetes is considered more severe than type 2 diabetes or GD.
A study done among children born between 1995 and 2009 found that women who were diagnosed with GD during the 26th week of pregnancy were 42 % more likely to have a child with autism.
A study done at Kaiser found that there was no increase in the risk of getting affected by autism if women who were pregnant got to know about the GD after the 26th week of pregnancy.
A new study found that there is no increased risk of autism for children of those women who were already affected by type 2 diabetes before pregnancy. The reason may be that the blood glucose levels are controlled among them.
A study could not explain why there is an increased risk of autism in children born to women with GD. The probable reason may be that high blood sugar levels may have long-lasting effects on fetus organ development and function.
A study found that children born to women with GD tend to be obese and at higher risk for diabetes later in life than other children.
Previously, it was thought that exposure to severe GD in utero could lead to brain malformations in the fetuses. Recent studies have noticed that mild GD can also cause brain malformations in the fetuses, and this may manifest into ASD.
It is noted that in recent years, there has been a rise in GD and ASD. This provides a possible link between GD and ASD. Early diagnosis and treatment may not reduce the risk of ASD due to GD, but this may help reduce other complications.
Very few studies have been done on the causative effect on fetus development. The study done on a mouse model noticed that high-fat diet-induced GD affected circulating immune factors in the maternal blood and cortical gene transcription in the fetus. Researchers found dysregulated gene expression, particularly in immune response and neurodevelopment genes.
One more study on a mouse model found an association of GD with altered neurodevelopment in the offspring. A study observed that women with diabetes and obesity before pregnancy were found to have four times the risk of developing autism. It was noticed that women with GD and obesity tend to have three times the risk of developing ASD.
Researchers found that glucose is toxic to many tissues, including the fetus's brain. The body releases other substances to fight the high glucose in the body. These substances may cause inflammation. This itself is harmful to the body.
Researchers noticed that excess boy fat, along with diabetes, may result in chronic inflammation. Diabetes may, apart from causing inflammation, cause reduced oxygen to the fetus. GD may influence the level of insulin, oxygen, and inflammation in the womb. This changes the environment in which the fetal brain develops.
Researchers also increase the risk of oxidative stress caused by free radicles. Free radicles produced during the reactions of metabolism may damage the tissues and cells and lead to cell death. Antioxidants help regulate the free radicles in the body. In GD, this balance is hampered, which leads to oxidative stress.
Conclusion:
Diabetes has been on the rise in recent years. It has various complications for the body and can affect many body parts. GD occurs only among pregnant women and can have effects on fetuses. Hence, it becomes important to know about GD, autism, and their links. Knowing about it may help in the early diagnosis of the conditions, leading to effective treatment. This further helps achieve a good quality of life.
