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Diabetes exposure in utero increases risk for ASD

Results from a large, multi-ethnic clinical study indicated an increased risk for autism spectrum disorders among children of mothers diagnosed with gestational diabetes by 26 weeks gestation.

To examine potential associations between maternal diabetes and autism spectrum disorders in offspring, Anny H. Xiang, PhD, of Kaiser Permanente Southern California, and colleagues reviewed records for 322,323 singleton children born from 1995 through 2009 at Kaiser Permanente Southern California hospitals and their mothers. Records included data from child behavior questionnaires administered at preventative care and well child visits as early as age 4 months, a brief screening checklist for autism spectrum disorders (ASD) at ages 18 and 24 months and any evaluations related to autism diagnosis. Children were followed until clinical diagnosis of ASD or December 2012, whatever occurred first.

Anny H. Xiang

Two percent of the study cohort were exposed to pre-existing type 2 diabetes, 7.8% were exposed to gestational diabetes and 90.2% were unexposed.

Overall, 3,388 children were diagnosed with ASD. Of these, 2,963 were unexposed to diabetes; 130 were exposed to gestational diabetes at less than 26 weeks; 180 were exposed to gestational diabetes at greater than 26 weeks; and 115 were exposed to type 2 diabetes. Unadjusted average annual incidences of ASD were 1.77 for children unexposed to diabetes, 2.14 for children exposed to type 2 diabetes and 3.26 for children exposed to gestational diabetes (P < .001).

Exposure to preexisting type 2 diabetes was associated with a hazard ratio of 1.59 (95% CI, 1.29-1.95) for ASD vs. non-exposure, while exposure to gestational diabetes at any time during pregnancy had a hazard ratio of 1.18 (95% CI, 1.04-1.33).

Older maternal age, being first born, high maternal education, low household income, history of comorbidity, preeclampsia/eclampsia, early delivery and being male were significantly associated with risk for ASD.

Among children exposed to preexisting type 2 diabetes or gestational diabetes, antidiabetic medication use was associated with a higher risk for ASD (HR = 1.44; 95% CI, 1.16-1.79) compared with nonuse. However, antidiabetic medication use was not independently associated with risk for ASD, the researchers noted.

When adjusting for differences in maternal age, parity, education, household income, race/ethnicity, history of comorbidity and sex of child, risk for ASD was not independently associated with preexisting type 2 diabetes or gestational diabetes. However, adjustment did not account for risk associated with exposure to gestational diabetes diagnosed by 26 weeks gestation, according to researchers.

Risk for ASD associated with exposure to gestational diabetes diagnosed by 26 weeks was independent of maternal smoking, BMI prior to pregnancy and gestational weight gain.

“In this large, multiethnic clinical cohort of singleton children born at 28 to 44 weeks gestation, exposure to [gestational diabetes] diagnosed by 26 weeks’ gestation was associated with risk of ASD in offspring,” Xiang and colleagues concluded. – by Amanda Oldt

Disclosure: The researchers report no relevant financial disclosures.