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Maternal obesity, diabetes associated with higher risk for autism

Maternal prepregnancy obesity and maternal diabetes, in combination, were associated with an increased risk for autism spectrum disorder and intellectual disability diagnoses in children, according to data published in Pediatrics.

 “Since the 1960s, prevalence rates of [autism spectrum disorder (ASD)] have increased dramatically, which cannot be entirely explained by changes in diagnostic practices,” Mengying Li, MSPH, of the department of population, family and reproductive health, at the Johns Hopkins Bloomberg School of Public Health in Baltimore, and colleagues wrote. “During a similar time frame, obesity and diabetes rose to epidemic levels in the United States. … Although obesity and diabetes are both comorbid, rarely have studies attempted to disentangle their independent and combined effects on ASD.”

To examine the independent and combined associations of maternal obesity and diabetes with ASD in children, and to contrast them with the effects on intellectual disability, attention-deficit/hyperactivity disorder (ADHD) and other developmental disorders, the researchers analyzed a subset of the Boston Birth Cohort, recruited at Boston Medical Center from 1998 to 2014, including mother-child pairs who had at least one postnatal follow-up. The subset included 2,734 children, of which 102 were diagnosed with ASD, 137 with intellectual disability, 301 with ADHD and 864 with other developmental disabilities.

Child ASD and other developmental disorders were based on physician diagnoses as documented in electronic medical records. Risks for ASD and other developmental disorders were compared among six groups, defined by maternal prepregnancy obesity and diabetes status by using Cox proportional hazard regression, controlling for potential cofounders.

According to the researchers, maternal prepregnancy obesity and pregestational diabetes, when examined individually, were each associated with risk for ASD. When examined in combination, mothers with obesity and pregestational diabetes (HR = 3.91; 95% CI, 1.76-8.68) and obesity with gestational diabetes (HR = 3.04; 95% CI, 1.21-7.63) had a significantly increased risk for ASD in offspring. For developmental disorders, only intellectual disability showed a similar pattern of increased risk associated with combined obesity and pregestational diabetes. According to the researchers, this pattern was mostly accounted for by cases with co-occurring ASD and intellectual disability.

“We demonstrated that pregnancy obesity and [pregestational diabetes] each were associated with a slightly increased risk of ASD, but the associations were most pronounced when mothers had both conditions,” Li and colleagues wrote. “This pattern of risk was observed for children with [intellectual disability], but not ADHD and other [developmental disorders]. Furthermore, our results suggested that the association of maternal obesity and diabetes with ASD and [intellectual disability] may be entirely due to those cases with co-occurring ASD and [intellectual disability].” – by Jason Laday