Did Diabetes in Pregnancy Cause My Child's ADHD? A Huge New Study Says Probably Not

What a study of 3.6 million mothers and children across seven countries found about diabetes in pregnancy and attention problems in children

If you developed diabetes during pregnancy, or lived with diabetes before you became pregnant, you may have worried about what it means for your child's future — including their ability to focus, sit still, and do well at school. That worry is common and completely understandable, and for years the answers from science were murky. A very large new study, following more than 3.6 million mothers and their children across seven countries, now offers welcome reassurance for the most common form of diabetes in pregnancy: it found that gestational diabetes is unlikely to actually cause attention-deficit/hyperactivity disorder (ADHD) in children [1]. This article explains what the researchers did, what they found, and what it means for families.

Why families and doctors have worried about this

Diabetes during pregnancy is very common — worldwide, roughly one pregnancy in six is affected by high blood sugar, and the numbers have been rising for years as more people develop diabetes and have children later in life [2]. There are two main kinds. Gestational diabetes appears only during pregnancy and usually goes away afterward. Pregestational diabetes (type 1 or type 2) is present before pregnancy begins. Doctors have long known that high blood sugar in pregnancy can affect a baby's size and early health, and managing it carefully brings real benefits [3].

More recently, researchers began asking a harder question: could high blood sugar during pregnancy also affect how a child's brain develops, making conditions like ADHD more likely? ADHD is a common condition — affecting roughly 5 to 7 out of every 100 children — that makes it harder to concentrate, control impulses, and stay still [4]. Earlier studies suggested a link. When their results were combined in 2019, they seemed to show that children of mothers with diabetes had about a 40% higher chance of ADHD [5]. That figure worried many parents. But those earlier studies had a stubborn problem they could not solve, and it is worth understanding what that problem was.

The problem that made earlier answers unreliable

The difficulty is that diabetes in pregnancy rarely travels alone. Families affected by diabetes often differ from other families in many ways at once — in genetics, income, stress, diet, and access to health care — and every one of those things can also influence a child's chance of developing ADHD. So when a study finds that children of mothers with diabetes have more ADHD, it cannot easily tell whether the diabetes caused it, or whether some other family characteristic is the real reason. One earlier study made this vivid: it found that gestational diabetes combined with financial hardship raised a child's ADHD risk far more than diabetes alone, showing just how tangled the exposure is with a family's circumstances [6]. Another large study added detail, finding that risk seemed highest for mothers with pre-existing diabetes and for those whose gestational diabetes was severe enough to need medication [7]. To get a trustworthy answer, scientists needed a study big enough, and clever enough, to separate the diabetes itself from everything that surrounds it.

How the researchers found a cleverer answer

Researchers led by Chan and colleagues, coordinated from the University of Hong Kong, pulled together health records from seven places: Hong Kong, New Zealand, Taiwan, and the Nordic countries of Finland, Iceland, Norway, and Sweden [1]. Altogether they linked more than 3.6 million mothers to their children, born between 2001 and 2014 and followed until 2020 — long enough for ADHD, which is often diagnosed once children reach school age, to show up. To protect privacy, the records never left each country; only the summarized results were combined.

Their key idea was to compare brothers and sisters. In a family where one pregnancy was affected by gestational diabetes and another was not, the siblings share the same parents, the same genes, and largely the same home life. So if diabetes during pregnancy truly caused ADHD, the sibling who was exposed to it should have a higher chance of ADHD than the sibling who wasn't. This "sibling comparison" is a powerful way to strip away the confusing family factors that tripped up earlier studies.

What they found

When the researchers looked across all families in the usual way, they saw a small increase in ADHD among children whose mothers had diabetes — modestly higher than in children whose mothers did not. The increase was larger for pre-existing diabetes than for gestational diabetes [1].

But the sibling comparison told a different and more revealing story. When they compared siblings — one exposed to gestational diabetes and one not — the difference in ADHD vanished. The exposed and unexposed siblings had essentially the same chance of ADHD [1]. In plain terms: once you compare children within the same family, gestational diabetes no longer appears to matter. That is exactly what you would expect if the small link seen across all families was really being driven by shared genetics and family circumstances, not by the pregnancy blood sugar itself. The researchers also noticed that mothers who needed medication for their gestational diabetes did not have children with any higher ADHD risk than mothers who managed it without medication — another sign that the diabetes itself was not the culprit.

What this means for your family

For a parent who had gestational diabetes, the takeaway is genuinely reassuring: this large, carefully designed study concludes that gestational diabetes is unlikely to have caused your child's ADHD, if your child has it. This is important, because many parents carry quiet guilt, wondering whether something during pregnancy was to blame. The best available evidence says that for gestational diabetes, the answer is very likely no. That does not mean managing blood sugar in pregnancy is unimportant — it protects your baby's health in other well-established ways — but you can set aside this particular worry.

The picture is a little less settled for pre-existing (type 1 or type 2) diabetes, where the link was stronger and the sibling test could not be applied in the same way. Scientists cannot yet say whether that stronger link reflects a real effect of long-standing high blood sugar around the time of conception, or once again reflects shared genetics and family factors. There are biological reasons why long-term high blood sugar might affect early brain development [8], so for parents with diabetes before pregnancy, the long-standing advice to get blood sugar well controlled before and early in pregnancy remains sensible.

Whatever the cause, a child with ADHD deserves support in their own right. ADHD is manageable, and children who are identified and helped can do well; getting the right support at school and at home matters far more to a child's future than knowing exactly why the ADHD developed [9], [10]. If you notice your child struggling with attention, activity, or impulsivity, speak with your pediatrician — not out of guilt about your pregnancy, but because early support helps.

What researchers are working on next

This study reshaped a long-standing question, but it did not close the book. Scientists now want to understand the stronger signal for pre-existing diabetes: is it real, or is it also explained by shared family factors? Answering that will take studies that combine the sibling approach with genetic testing and precise measurements of blood sugar at different stages of pregnancy. For families today, though, the headline is clear and comforting: for the most common form of diabetes in pregnancy, the evidence says the condition itself is very unlikely to be the reason a child develops ADHD.

References

  1. Chan AYL, Gao L, Hsieh MH-C, Kjerpeseth LJ, Avelar R, Banaschewski T, et al. Maternal diabetes and risk of attention-deficit/hyperactivity disorder in offspring in a multinational cohort of 3.6 million mother–child pairs. Nature Medicine. 2024;30(5):1416–1423. doi:10.1038/s41591-024-02917-8 ↩
  2. Yuen L, Saeedi P, Riaz M, et al. Projections of the prevalence of hyperglycaemia in pregnancy in 2019 and beyond: results from the International Diabetes Federation Diabetes Atlas, 9th edition. Diabetes Res Clin Pract. 2019;157:107841. doi:10.1016/j.diabres.2019.107841 ↩
  3. Alexopoulos AS, Blair R, Peters AL. Management of preexisting diabetes in pregnancy: a review. JAMA. 2019;321(18):1811–1819. doi:10.1001/jama.2019.4981 ↩
  4. Thomas R, Sanders S, Doust J, Beller E, Glasziou P. Prevalence of attention-deficit/hyperactivity disorder: a systematic review and meta-analysis. Pediatrics. 2015;135(4):e994–e1001. doi:10.1542/peds.2014-3482 ↩
  5. Zhao L, Li X, Liu G, Han B, Wang J, Jiang X. The association of maternal diabetes with attention deficit and hyperactivity disorder in offspring: a meta-analysis. Neuropsychiatr Dis Treat. 2019;15:675–684. doi:10.2147/NDT.S189200 ↩
  6. Nomura Y, Marks DJ, Grossman B, et al. Exposure to gestational diabetes mellitus and low socioeconomic status: effects on neurocognitive development and risk of attention-deficit/hyperactivity disorder in offspring. Arch Pediatr Adolesc Med. 2012;166(4):337–343. doi:10.1001/archpediatrics.2011.784 ↩
  7. Xiang AH, Wang X, Martinez MP, Getahun D, Page KA, Buchanan TA, et al. Maternal gestational diabetes mellitus, type 1 diabetes, and type 2 diabetes during pregnancy and risk of ADHD in offspring. Diabetes Care. 2018;41(12):2502–2508. doi:10.2337/dc18-0733 ↩
  8. Ornoy A, Reece EA, Pavlinkova G, Kappen C, Miller RK. Effect of maternal diabetes on the embryo, fetus, and children: congenital anomalies, genetic and epigenetic changes and developmental outcomes. Birth Defects Res C Embryo Today. 2015;105(1):53–72. doi:10.1002/bdrc.21090 ↩
  9. Fleming M, Fitton CA, Steiner MFC, et al. Educational and health outcomes of children treated for attention-deficit/hyperactivity disorder. JAMA Pediatr. 2017;171(7):e170691. doi:10.1001/jamapediatrics.2017.0691 ↩
  10. Pastor PN, Reuben CA. Identified attention-deficit/hyperactivity disorder and medically attended, nonfatal injuries: US school-age children, 1997–2002. Ambul Pediatr. 2006;6(1):38–44. doi:10.1016/j.ambp.2005.07.002 ↩