Fetal behavior as a window to later gross motor function: a 10-year follow-up of children prenatally exposed to gestational diabetes mellitus.

Introduction: Gestational diabetes mellitus (GDM) has been associated with adverse neurodevelopmental outcomes in early childhood, but evidence regarding its long-term association with gross motor functioning remains limited. This 10-year follow-up study examined gross motor outcomes at approximately ten years of age in children prenatally exposed to diet-treated GDM and children from uncomplicated pregnancies, building on a prospectively established cohort in which fetal neurobehavior had previously been assessed. Methods: The study included 100 children, with 50 participants in each group. Gross motor functioning was assessed across six domains: coordination, agility, flexibility, explosive strength, muscular endurance, and balance. Given that several motor outcomes deviated from normality, Aligned Rank Transform (ART) factorial ANOVA was used to examine the effects of group, sex, and the group × sex interaction. Benjamini-Hochberg false discovery rate correction was applied to the p-values for the main effect of group to account for multiple comparisons. Results: Gross motor functioning was largely comparable between the groups, with no significant main effect of group for most motor outcomes or any balance parameter. However, significant group effects were identified for three specific motor tasks and remained statistically significant after FDR correction: children in the GDM-exposed group performed poorer in squats and ball rolling with the non-dominant hand, while they performed better in the straddle forward bend. The magnitude of the group effects was moderate for squats and straddle forward bend and large for ball rolling with the non-dominant hand. Discussion: These findings do not indicate generalized gross motor impairment but suggest that prenatal exposure to the metabolic environment associated with GDM may be related to subtle, task-specific differences in motor functioning that remain detectable during school age. Further longitudinal research is needed to determine the developmental stability and clinical relevance of these outcomes.