Background: Gestational diabetes mellitus (GDM), a condition characterized by high blood sugar levels during pregnancy, is increasingly prevalent globally. While resolving after delivery, GDM can have lasting implications for the developing fetus, particularly regarding neurodevelopmental outcomes. This impact is garnering significant attention within the medical community, driving research into the underlying mechanisms and potential interventions. We aimed to investigate the prevalence and impact of gestational diabetes mellitus (GDM) on neurodevelopmental outcomes in infants. Methods: This retrospective cohort study was conducted using data collected from 2018 to 2022 at Zhongnan Hospital of Wuhan University. A total of 1430 mothers with gestational diabetes mellitus (GDM) and 1430 infants, aged 0 to 12 months, were included in the study. The inclusion criteria were as follows: mothers with a confirmed diagnosis of gestational diabetes mellitus and no history of pre-gestational diabetes mellitus, and infants aged 0 to 12 months born to these mothers with GDM. Results: A total of 1430 infants were included in the study, of which 832 (58.18%) were male and 598 (41.82%) were female. The prevalence of gestational diabetes mellitus (GDM) was 68.65%. The results of the Denver II Developmental Screening Test (DDST) were as follows: 1370 infants (95.80%) had normal development, 8 infants (0.56%) had abnormal development, 44 infants (3.10%) had suspicious development, and 8 infants (0.56%) were unable to be assessed. Factors associated with a higher likelihood of abnormal findings on the DDST included being a primiparous mother (p < 0.001), having a normal head circumference (p = 0.002), being under 6 months old (p = 0.043), and having a normal anterior fontanelle (p < 0.001). Regarding mental responses, infants with normal head circumference or microcephaly had poorer mental responses compared to those with macrocephaly (p < 0.001). Additionally, infants with lower birth weights (1 - 1.5 kg, 1.5 - 2.5 kg, and 2.5 - 4 kg) and a normal anterior fontanelle exhibited abnormal mental responses (all p < 0.001). No statistically significant differences in mental response were found based on gender, maternal age, gestational age, delivery method, or birth length (p > 0.05). Conclusion: The findings from this study underscore the significant impact of gestational diabetes mellitus on neurodevelopmental outcomes in exposed infants to GDM. Infants born to mothers with GDM showed varied neurodevelopmental and mental response
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