Association of Gestational Diabetes Mellitus Complicated with Short Sleep Duration and Child Neurodevelopmental Delay

Authors：Yuanyuan Zhu, Haixia Wang, Ruirui Ma, Lei Zhang, Yuhong Wang, Yu Zhang, Ziyu Shao, Daomin Zhu , Peng Zhu

Source：J Clin Endocrinol Metab. 2023 Jul 29:dgad446.

DOI: 10.1210/clinem/dgad446.

Abstract：

Context: Gestational diabetes mellitus (GDM) is a risk factor for child neurodevelopmental delay. Maternal short sleep duration (SSD) may aggravate glucose metabolism disorder in GDM women. However, it is unclear whether maternal SSD will further affect the neurodevelopmental outcomes of children.

Objective: To identify the association of GDM complicated with SSD and child neurodevelopmental delay.

Methods: This prospective study included 7069 mother-child pairs. Between 24 and 28 weeks of gestation, GDM was based on the 75-g oral-glucose-tolerance test (OGTT). Self-reported sleep duration was collected via the Pittsburgh Sleep Quality Index (PSQI) questionnaire in the second (24-28 weeks) and third (32-36 weeks) trimesters. Outcomes of neurodevelopmental delay in 6-36 months postpartum were evaluated using Denver Developmental Screening Test-II (DDST-II) and Gesell Development Diagnosis Scale (GDDS).

Results: Compared with the unexposed group, women with 'GDM + SSD' have the greatest risks of child neurodevelopmental delay [HR with 95% CI: 1.58 (1.03,2.44)]. 'GDM + SSD' was associated with the greatest risks of maternal-fetal glucose metabolic disorder. An IQR (0.58 mmol/L) increase in cord blood C-peptide was associated with the risk of child neurodevelopmental delay [HR with 95% CI: 1.28(1.12, 1.48)]. The stronger linear association of maternal glucose metabolism profiles and C-peptide in women with 'GDM + SSD' was also demonstrated. The proportion of association between 'GDM + SSD' and child neurodevelopmental delay mediated by C-peptide was 14.4%.

Conclusion: GDM complicated with SSD was associated with increased risk for child neurodevelopmental delay by enhancing the intergenerational association of maternal-fetal glucose metabolism disorder.

摘要：

背景：妊娠糖尿病（GDM）是导致儿童神经发育迟缓的一个危险因素。产妇睡眠时间短（SSD）可能会加重 GDM 妇女的糖代谢紊乱。然而，目前尚不清楚产妇睡眠时间过短是否会进一步影响儿童神经发育的结果。

目的：确定 GDM 并发 SSD 与儿童神经发育迟缓的关系。

方法：这项前瞻性研究包括 7069 对母婴。在妊娠24周至28周期间，GDM以75克口服葡萄糖耐量试验（OGTT）为依据。在第二孕期（24-28 周）和第三孕期（32-36 周），通过匹兹堡睡眠质量指数 (PSQI) 问卷收集自我报告的睡眠时间。使用丹佛发育筛查测试II（DDST-II）和格塞尔发育诊断量表（GDDS）对产后6-36个月的神经发育延迟结果进行了评估。

结果：与未暴露组相比，患有 "GDM + SSD "的妇女患儿童神经发育迟缓的风险最大[HR（95% CI）：1.58 (1.03,2.44)]。GDM + SSD "与母胎糖代谢紊乱的最大风险相关。脐带血 C 肽的 IQR（0.58 毫摩尔/升）增加与儿童神经发育迟缓的风险有关[HR（95% CI）：1.28（1.12，1.48）]。在 "GDM + SSD "妇女中，母体糖代谢概况与 C 肽的线性关系也更强。由 C 肽介导的 "GDM + SSD "与儿童神经发育迟缓的关联比例为 14.4%。

结论：GDM 并发 SSD 与儿童神经发育迟缓的风险增加有关，这是因为母胎糖代谢紊乱的代际关联增强了。