Maternal Glucose Metabolism and Emotional and Behavioral Problems in Offspring: Modification by Erythrocyte Polyunsaturated Fatty Acids

Background: Gestational diabetes mellitus (GDM) adversely affects offspring neurobehavioral outcomes, yet evidence regarding continuous markers of maternal glucose metabolism remains limited. Although polyunsaturated fatty acids (PUFAs) have been shown to affect associations between glucose metabolism and respiratory outcomes, their effects on children’s emotional and behavioral problems remain unclear. This study investigated the association between maternal glucose metabolism and emotional and behavioral problems in children and the potential modifying effect of maternal erythrocyte PUFAs. Methods: This prospective birth cohort included 481 mother–child pairs. Maternal glucose metabolism during pregnancy was assessed using GDM diagnosis via a 75 g oral glucose tolerance test (OGTT), fasting plasma glucose (FPG), 1 h and 2 h OGTT glucose, hemoglobin A1c (HbA1c), insulin, and insulin resistance (HOMA-IR). Maternal erythrocyte PUFAs were quantified by gas chromatography. Children’s emotional and behavioral problems at age 5 years were assessed using the Strengths and Difficulties Questionnaire (SDQ). Generalized linear models were used to evaluate associations, including multiplicative interaction terms between glucose metabolism indicators and PUFAs. Results: Maternal FPG (OR = 1.63; 95%CI: 1.08–2.47), OGTT-1h glucose (OR = 1.84; 95%CI: 1.08–3.12), and HOMA-IR (OR = 1.52; 95%CI: 1.01–2.27) were each positively associated with an increased risk of abnormal total difficulties scores in children. Maternal insulin levels were positively associated with abnormal total difficulties scores in girls (p for interaction < 0.05). Higher maternal n-3 PUFA levels and lower n-6 PUFA levels attenuated the risk of glucose metabolism-related emotional and behavioral problems in children. Conclusion: Maternal glucose metabolism was associated with increased risk of emotional and behavioral problems in children. PUFA biomarkers could modify glucose-related emotional and behavioral outcomes in children.