{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T15:12:07Z","timestamp":1784128327977,"version":"3.55.0"},"reference-count":37,"publisher":"American Diabetes Association","issue":"12","license":[{"start":{"date-parts":[[2018,11,20]],"date-time":"2018-11-20T00:00:00Z","timestamp":1542672000000},"content-version":"vor","delay-in-days":22,"URL":"http:\/\/www.diabetesjournals.org\/content\/license"}],"content-domain":{"domain":["diabetesjournals.org"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2018,12,1]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>To examine the relative importance of maternal preexisting type 1 diabetes (T1D), preexisting type 2 diabetes (T2D), and gestational diabetes mellitus (GDM) on risk of attention deficit\/hyperactivity disorder (ADHD) in offspring.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESEARCH DESIGN AND METHODS<\/jats:title>\n                    <jats:p>This retrospective birth cohort study included 333,182 singletons born in 1995\u20132012 within Kaiser Permanente Southern California hospitals. Children were prospectively followed through electronic medical records from age 4 years. Relative risks of ADHD associated with diabetes exposures in utero were estimated by hazard ratios (HRs) using Cox regression with adjustment for potential confounders. For GDM, timing of exposure was evaluated by gestational age at diagnosis and severity was assessed by the need for antidiabetes medication treatment during pregnancy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>A total of 37,878 (11.4%) children were exposed to diabetes (522 exposed to T1D, 7,822 T2D, and 29,534 GDM). During a median of 4.9 years (interquartile range 2.2, 9.6) of follow-up after age 4 years, 17,415 (5.2%) children were diagnosed with ADHD. ADHD risk was not associated with GDM taken as a whole (P = 0.50) or with gestational age at GDM diagnosis (P = 0.16). However, the risk was significantly greater for the GDM requiring versus not requiring antidiabetes medications (P &amp;lt; 0.001). Compared with children unexposed to diabetes, the adjusted HRs for ADHD in children were 1.57 (95% CI 1.09\u20132.25) for exposure to T1D, 1.43 (1.29\u20131.60) for T2D, 1.26 (1.14\u20131.41) for GDM requiring antidiabetes medications, and 0.93 (0.86\u20131.01) for GDM not requiring medications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>The hierarchy of risks suggests that severity of maternal diabetes (T1D vs. T2D vs. GDM requiring antidiabetes medications) influences the risk of ADHD in offspring of mothers with diabetes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2337\/dc18-0733","type":"journal-article","created":{"date-parts":[[2018,10,29]],"date-time":"2018-10-29T11:15:16Z","timestamp":1540811716000},"page":"2502-2508","update-policy":"https:\/\/doi.org\/10.2337\/ada-journal-policies","source":"Crossref","is-referenced-by-count":125,"title":["Maternal Gestational Diabetes Mellitus, Type 1 Diabetes, and Type 2 Diabetes During Pregnancy and Risk of ADHD in Offspring"],"prefix":"10.2337","volume":"41","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2786-1268","authenticated-orcid":false,"given":"Anny H.","family":"Xiang","sequence":"first","affiliation":[{"name":"Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xinhui","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mayra P.","family":"Martinez","sequence":"additional","affiliation":[{"name":"Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Darios","family":"Getahun","sequence":"additional","affiliation":[{"name":"Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9083-6615","authenticated-orcid":false,"given":"Kathleen A.","family":"Page","sequence":"additional","affiliation":[{"name":"Division of Endocrinology and Diabetes, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas A.","family":"Buchanan","sequence":"additional","affiliation":[{"name":"Division of Endocrinology and Diabetes, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Klara","family":"Feldman","sequence":"additional","affiliation":[{"name":"Obstetrics and Gynecology, Kaiser Permanente Southern California, Pasadena, CA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1167","published-online":{"date-parts":[[2018,10,29]]},"reference":[{"key":"2022031301181233900_B1","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1002\/bdrc.21090","article-title":"Effect of maternal diabetes on the embryo, fetus, and children: congenital anomalies, genetic and epigenetic changes and developmental outcomes","volume":"105","author":"Ornoy","year":"2015","journal-title":"Birth Defects Res C Embryo Today"},{"key":"2022031301181233900_B2","doi-asserted-by":"crossref","first-page":"1425","DOI":"10.1001\/jama.2015.2707","article-title":"Association of maternal diabetes with autism in offspring","volume":"313","author":"Xiang","year":"2015","journal-title":"JAMA"},{"key":"2022031301181233900_B3","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1001\/jama.2018.7614","article-title":"Maternal type 1 diabetes and risk of autism in offspring","volume":"320","author":"Xiang","year":"2018","journal-title":"JAMA"},{"key":"2022031301181233900_B4","doi-asserted-by":"crossref","first-page":"1023","DOI":"10.2337\/diab.29.12.1023","article-title":"Banting lecture 1980. 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