pitcher-reducedcortical-2018.pdf (751.81 kB)
Reduced cortical excitability, neuroplasticity, and salivary cortisol in 11–13-year-old children born to women with gestational diabetes mellitus
journal contribution
posted on 2018-05-01, 00:00 authored by J M Van Dam, A J Garrett, L A Schneider, N A Hodyl, M R Goldsworthy, S Coat, J A Rowan, W M Hague, Julia PitcherBackground: Children exposed to gestational diabetes mellitus (GDM) in utero are at increased risk of neurodevelopmental difficulties, including autism and impaired motor control. However, the underlying neurophysiology is unknown. Methods: Using transcranial magnetic stimulation, we assessed cortical excitability, long-term depression (LTD)-like neuroplasticity in 45 GDM-exposed and 12 control children aged 11–13 years. Data were analysed against salivary cortisol and maternal diabetes severity and treatment (insulin [N = 22] or metformin [N = 23]) during pregnancy. Findings: GDM-exposed children had reduced cortical excitability (p =.003), LTD-like neuroplasticity (p =.005), and salivary cortisol (p <.001) when compared with control children. Higher maternal insulin resistance (IR) before and during GDM treatment was associated with a blunted neuroplastic response in children (p =.014) and this was not accounted for by maternal BMI. Additional maternal and neonatal measures, including fasting plasma glucose and inflammatory markers, predicted neurophysiological outcomes. The metformin and insulin treatment groups had similar outcomes. Interpretation: These results suggest that GDM can contribute to subtle differences in child neurophysiology, and possibly cortisol secretion, persisting into early adolescence. Importantly, these effects appear to occur during second trimester, before pharmacologic treatment typically commences, and can be predicted by maternal insulin resistance. Therefore, earlier detection and treatment of GDM may be warranted. Metformin appears to be safe for these aspects of neurodevelopment.
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Journal
EBioMedicineVolume
31Pagination
143 - 149Publisher
ElsevierLocation
Amsterdam, The NetherlandsPublisher DOI
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2352-3964Language
engPublication classification
C1 Refereed article in a scholarly journalUsage metrics
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