Gestational Diabetes Mellitus Increases the Risk of Atopic Dermatitis in Children: A National Retrospective Study with Analysis by Treatment Modality

INTRODUCTION: Atopic dermatitis (AD) is a common childhood inflammatory disease influenced by genetic and environmental factors. Maternal metabolic conditions, including gestational diabetes mellitus (GDM), may affect offspring risk, but large population-based studies are limited. We aimed to examine the association between maternal GDM and offspring AD, and whether risk varies by maternal diabetes treatment type. METHODS: We conducted a retrospective cohort study of 326,611 mother-child dyads from Clalit Health Services, Israel, between 2010 and 2023. GDM was classified as diet-controlled (A1) or pharmacologically treated (A2). Offspring AD was identified using ICD-10 codes. Multivariable logistic regression estimated adjusted odds ratios (aORs), controlling for maternal age, allergic history, smoking, gestational age, infant sex, and follow-up duration. RESULTS: Of 16,008 (4.9%) mothers with GDM, offspring AD prevalence was higher than in non-GDM offspring (28% vs. 26%, p < 0.001). Maternal GDM was independently associated with increased offspring AD risk (aOR 1.07, 95% CI 1.03-1.11, p < 0.001). Additional independent predictors included maternal allergic rhinitis, asthma, smoking, male sex, and shorter gestational age. CONCLUSION: Maternal GDM is associated with an increased risk of AD in offspring, independent of maternal allergic and perinatal factors, though causality cannot be inferred because of the retrospective study design. These findings may suggest a role of maternal metabolic health in early-life immune and skin barrier development.