Review Article

Association of Maternal Diabetes and ADHD in Offspring: A Systematic Review and Meta-Analysis


A systematic review and meta-analysis was conducted to determine the association between exposure to maternal diabetes and ADHD in the offspring. Major electronic databases, including Web of Science, PubMed, Scopus, Embase, and Proquest, were searched from inception until December 2018. The New Castle-Ottawa scale was used to assess the quality of the included studies. A fixed effects model was applied for analysis. Seven studies including a total of 5,658,871 individuals were retained. A significant association was found between maternal diabetes and ADHD [OR=1.23, 95% CI: 1.117, 1.345]. There was a significant heterogeneity (I^2=77.7, P<0.0001), while Egger’s and Begg’s test were not significant. This study showed a significant relationship between maternal diabetes and ADHD; however, more well-designed studies are needed to confirm the results.

1. Camprubi Robles M, Campoy C, Garcia Fernandez L, Lopez-Pedrosa JM, Rueda R, Martin MJ. Maternal diabetes and cognitive performance in the offspring: a systematic review and meta-analysis. PLoS One. 2015;10(10).
2. Xiong X, Saunders L, Wang F, Demianczuk N. Gestational diabetes mellitus: prevalence, risk factors, maternal and infant outcomes. International Journal of Gynecology & Obstetrics. 2001;75(3):221-8.
3. Lawrence JM, Contreras R, Chen W, Sacks DA. Trends in the prevalence of preexisting diabetes and gestational diabetes mellitus among a racially/ethnically diverse population of pregnant women, 1999–2005. Diabetes care. 2008;31(5):899-904.
4. Xiang AH, Wang X, Martinez MP, Page K, Buchanan TA, Feldman RK. Maternal type 1 diabetes and risk of autism in offspring. Jama. 2018;320(1):89-91.
5. Temple R, Hardiman M, Pellegrini M, Horrocks L, Martinez‐Cengotitabengoa MT. Cognitive function in 6‐to 12‐year‐old offspring of women with Type 1 diabetes. Diabetic Medicine. 2011;28(7):845-8.
6. Fraser A, Nelson SM, Macdonald-Wallis C, Lawlor DA. Associations of existing diabetes, gestational diabetes, and glycosuria with offspring IQ and educational attainment: the Avon Longitudinal Study of Parents and Children. Experimental diabetes research. 2012;2012.
7. Clausen TD, Mortensen E, Schmidt L, Mathiesen E, Hansen T, Jensen D, et al. Cognitive function in adult offspring of women with Type 1 diabetes. Diabetic Medicine. 2011;28(7):838-44.
8. Polanczyk G, De Lima MS, Horta BL, Biederman J, Rohde LA. The worldwide prevalence of ADHD: a systematic review and metaregression analysis. American journal of psychiatry. 2007;164(6):942-8.
9. Fayyad J, De Graaf R, Kessler R, Alonso J, Angermeyer M, Demyttenaere K, et al. Cross-national prevalence and correlates of adult attention-deficit hyperactivity disorder. The British Journal of Psychiatry. 2007;190(5):402-9.
10. Thapar A, Cooper M, Eyre O, Langley K. Practitioner review: what have we learnt about the causes of ADHD? Journal of Child Psychology and Psychiatry. 2013;54(1):3-16.
11. Cortese S, Moreira-Maia CR, St. Fleur D, Morcillo-Peñalver C, Rohde LA, Faraone SV. Association between ADHD and obesity: a systematic review and meta-analysis. American Journal of Psychiatry. 2016;173(1):34-43.
12. Schneider ML, Roughton EC, Lubach GR. Moderate alcohol consumption and psychological stress during pregnancy induce attention and neuromotor impairments in primate infants. Child development. 1997;68(5):747-59.
13. Olson HC, Streissguth AP, Sampson PD, Barr HM, Bookstein FL, Thiede K. Association of prenatal alcohol exposure with behavioral and learning problems in early adolescence. Journal of the American Academy of Child & Adolescent Psychiatry. 1997;36(9):1187-94.
14. Zhu JL, Olsen J, Liew Z, Li J, Niclasen J, Obel C. Parental smoking during pregnancy and ADHD in children: the Danish national birth cohort. Pediatrics. 2014;134(2):e382-e8.
15. Sullivan EL, Riper KM, Lockard R, Valleau JC. Maternal high-fat diet programming of the neuroendocrine system and behavior. Hormones and behavior. 2015;76:153-61.
16. Nielsen PR, Benros ME, Dalsgaard S. Associations between autoimmune diseases and attention-deficit/hyperactivity disorder: a nationwide study. Journal of the American Academy of Child & Adolescent Psychiatry. 2017;56(3):234-40. e1.
17. Ji J, Chen T, Sundquist J, Sundquist K. Type 1 diabetes in parents and risk of attention deficit/hyperactivity disorder in offspring: a population-based study in Sweden. Diabetes Care. 2018;41(4):770-4.
18. Instanes JT, Halmøy A, Engeland A, Haavik J, Furu K, Klungsøyr K. Attention-deficit/hyperactivity disorder in offspring of mothers with inflammatory and immune system diseases. Biological psychiatry. 2017;81(5):452-9.
19. Daraki V, Roumeliotaki T, Koutra K, Georgiou V, Kampouri M, Kyriklaki A, et al. Effect of parental obesity and gestational diabetes on child neuropsychological and behavioral development at 4 years of age: the Rhea mother-child cohort, Crete, Greece. Eur Child Adolesc Psychiatry. 2017;26(6):703-14. doi:10.1007/s00787-016-0934-2. [PubMed:28050707].
20. Tarver J, Daley D, Sayal K. Attention‐deficit hyperactivity disorder (ADHD): an updated review of the essential facts. Child: care, health and development. 2014;40(6):762-74.
21. Lahey BB, Lee SS, Sibley MH, Applegate B, Molina BS, Pelham WE. Predictors of adolescent outcomes among 4–6-year-old children with attention-deficit/hyperactivity disorder. Journal of abnormal psychology. 2016;125(2):168.
22. Chan E, Fogler JM, Hammerness PG. Treatment of attention-deficit/hyperactivity disorder in adolescents: a systematic review. Jama. 2016;315(18):1997-2008.
23. Barkley RA, Fischer M, Smallish L, Fletcher K. Young adult outcome of hyperactive children: adaptive functioning in major life activities. Journal of the American Academy of Child & Adolescent Psychiatry. 2006;45(2):192-202.
24. Barkley RA, Fischer M, Smallish L, Fletcher K. Young adult follow‐up of hyperactive children: antisocial activities and drug use. Journal of child psychology and psychiatry. 2004;45(2):195-211.
25. Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. European journal of epidemiology. 2010;25(9):603-5.
26. Egger M, Smith GD, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. Bmj. 1997;315(7109):629-34.
27. Schmitt J, Romanos M. Prenatal and perinatal risk factors for attention-deficit/hyperactivity disorder. Archives of pediatrics & adolescent medicine. 2012;166(11):1074-5.
28. Nomura Y, Marks DJ, Grossman B, Yoon M, Loudon H, Stone J, et al. Exposure to gestational diabetes mellitus and low socioeconomic status: effects on neurocognitive development and risk of attention-deficit/hyperactivity disorder in offspring. Archives of pediatrics & adolescent medicine. 2012;166(4):337-43.
29. Bytoft B, Knorr S, Vlachova Z, Jensen RB, Mathiesen ER, Beck-Nielsen H, et al. Assessment of attention deficits in adolescent offspring exposed to maternal type 1 diabetes. PloS one. 2017;12(1).
30. Yamamoto JM, Benham JL, Dewey D, Sanchez JJ, Murphy HR, Feig DS, et al. Neurocognitive and behavioural outcomes in offspring exposed to maternal pre-existing diabetes: a systematic review and meta-analysis. Diabetologia. 2019;62(9):1561-74.
31. Ornoy A, Ratzon N, Greenbaum C, Wolf A, Dulitzky M. School-age children born to diabetic mothers and to mothers with gestational diabetes exhibit a high rate of inattention and fine and gross motor impairment. Journal of Pediatric Endocrinology and Metabolism. 2001;14(Supplement):681-90.
32. Kong L, Norstedt G, Schalling M, Gissler M, Lavebratt C. The risk of offspring psychiatric disorders in the setting of maternal obesity and diabetes. Pediatrics. 2018;142(3). doi:10.1542/peds.2018-0776.
IssueVol 61 No 6 (2023) QRcode
SectionReview Article(s)
Attention deficit disorder with hyperactivity Diabetes mellitus Systematic review

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
Okhovat Isfahani B, Khodamoradi F. Association of Maternal Diabetes and ADHD in Offspring: A Systematic Review and Meta-Analysis. Acta Med Iran. 2023;61(6):315-322.