Gestational Diabetes Linked to Reduced Lung Function in Children

Gestational diabetes may be a risk factor for reduced lung function, a new study found.1

“[Gestational diabetes mellitus] was associated with a modest decrease in baseline FEV1 in children, and further research is needed to determine if this finding translates into early adulthood lung function deficits that have been associated with long-term respiratory decline,” wrote study investigator Margaret A. Adgent, PhD, MSPH, of Vanderbilt University Medical Center, and colleagues.

Lung development begins around 4 weeks’ gestation, with most structural growth occurring during fetal and early postnatal life. Low lung function early in life predicts reduced lung function in adulthood and is associated with adverse health outcomes, including an increased risk of persistent asthma in children.2

Investigators recognized the need to characterize prenatal risk factors for low lung function and persistent lung disease.1 Prior research suggests that gestational diabetes mellitus may be a prenatal risk factor for respiratory disease in children due to hyperglycemia, placental inflammation, altered immune response, and oxidative stress during susceptible windows of fetal lung development.

In this study, investigators assessed the association between gestational diabetes mellitus and lung function, as well as current asthma and wheeze, in children aged 8 – 9 years. The study included 722 mother-child dyads from the Conditions Affecting Neurocognitive Development in Early Childhood (CANDLE) study, a socioeconomically and racially diverse prospective US pregnancy cohort based in Shelby County, Tennessee.1

CANDLE enrolled women aged 16 – 40 years (mean, 26 years) during the second trimester of pregnancy who were pregnant with their first child, not considered medically low-risk (i.e., no chronic hypertension requiring medication, oligohydramnios, or type 1 diabetes), and planned to deliver at a study hospital. Births occurred between December 2006 and June 2011.

Among participants, 66% identified as Black or African American and 34% identified as non-Black (33% White, 0.5% Asian, and 0.5% other); 98% identified as non-Hispanic. More than half of the women had a high school education or less (56%), and 50% gave birth to male children.

Participants completed questionnaires and provided biospecimens during the second and third trimesters of pregnancy and at delivery, and attended follow-up visits at ages 1, 2, and 3 years, at approximately 4.5 years, and 8 – 9 years. This current analysis included participants with documented gestational diabetes mellitus status, gestational age at delivery of ≥ 32 weeks, acceptable function test data (determined by pulmonologist review), or a respiratory outcome questionnaire completed at ages 8 – 9 years.

Pulmonary function tests, conducted using the software Breezesuite, assessed forced expiratory volume in the first second (FEV1), forced vital capacity (FVC), the FEV1/FVC ratio, and forced expiratory flow between 25% and 75% of vital capacity (FEF25-75). Childhood respiratory outcomes were assessed using a questionnaire based on the International Study of Asthma and Allergies in Children (ISAAC).

Wheeze was defined as wheezing or whistling in the chest in the previous 12 months, despite no cold. Current asthma was defined as meeting ≥ 2 of the following: current wheeze, physician-diagnosed asthma or reactive airway disease, or reported asthma-specific medication use in the previous 12 months.

The analysis adjusted for many covariates, including age, race, ethnicity, prenatal smoking, pre-pregnancy weight and height, and education level.

Gestational diabetes mellitus was identified in 6% of pregnancies. Median pulmonary function z scores were −0.46 for FEV1, −0.41 for FVC, −0.08 for FEV1/FVC, and −0.34 for FEF25–75. After adjustment, children exposed to gestational diabetes had lower FEV1 (95% CI, −0.55 to −0.00) and FEF25–75 (95% CI, −0.76 to −0.10), as well as higher odds of current asthma (OR, 3.12; 95% CI, 1.55 to 6.28), compared with unexposed children. No differences were observed for other lung function measures.1

“[Gestational diabetes mellitus] is already recognized as a risk factor for multiple pregnancy complications and childhood morbidities, such as obesity and type 2 diabetes. This study highlights a possible relationship between [gestational diabetes mellitus] and childhood lung function, which is a meaningful indicator for long-term health. However, as our study is based on [a] few [gestational diabetes mellitus] exposed pregnancies, continued investigation into the long-term impacts of [gestational diabetes mellitus] on offspring respiratory development and health outcomes in larger studies is needed.”

References

1. Adgent MA, Gebretsadik T, Moore PE, et al. Gestational diabetes and childhood lung function at age 8-9 years in a diverse US cohort. Ann Allergy Asthma Immunol. Published online December 10, 2025. doi:10.1016/j.anai.2025.12.006

2. Sánchez-Solís M. Early Lung Function and Future Asthma. Front Pediatr. 2019 Jun 19;7:253. doi: 10.3389/fped.2019.00253. PMID: 31275912; PMCID: PMC6593473.