(458) Periconception Hemoglobin A1c and the Risk of Neurodevelopmental Disorders in the Offspring

Maternal pregestational diabetes is associated with an increased risk of neurodevelopmental disorders in children. The objective of this study is to evaluate whether periconception hemoglobin A1c (A1c) is associated with the diagnosis of a neurodevelopmental disorder (ND) among offspring.

Study Design:

This retrospective cohort included live singleton births with an observed periconception A1c from 2016–2023 across four hospitals in an integrated healthcare system. Periconception A1c was defined as the nearest A1c within 90 days before or after the estimated date of conception. The outcome of interest was documentation of a ND (ICD-10 diagnostic codes F80-F84) in the offspring electronic health record. Multiple logistic regression with cluster-robust standard errors was used to assess the association between A1c and ND. Models were adjusted for maternal age, race/ethnicity, insurance status, pre-pregnancy BMI, infant sex, and preterm birth.

Results:

Of the 16,917 included pregnancies, ND was identified in 1,013 (6.0%) offspring. The average periconception A1c was 5.2 (SD 0.6). 1,452 had a diagnosis of pregestational diabetes (8.6%). In the adjusted model, a 1-point increase in periconception A1c was associated with 12% increased odds of a ND diagnosis (aOR 1.12; [95% CI 1.02–1.22]; see Table 1). BMI, Hispanic ethnicity, public insurance, male sex, and preterm birth were also associated with increased ND risk.

Conclusion:

Periconception hyperglycemia is associated with increased risk of ND in offspring in early childhood. These findings highlight the preconception period as a critical intervention window for improving long-term offspring ND outcomes.