Maternal diabetes linked to autism

Type 1, Type 2 and gestational diabetes have been linked with autism spectrum disorder in this US study

Researchers have found a link between Type 1 diabetes (T1D), Type 2 diabetes (T2D) and gestational diabetes mellitus (GDM) in a retrospective cohort study of children born at 28 to 44 weeks’ gestation across Kaiser Permanente Southern California (KPSC) hospitals from 1995 to 2012.

According to a research letter published in the Journal of the American Medical Association and presented at the 78th Scientific Sessions of the American Diabetes Association this month, children were tracked through electronic health records from age one until the first date of the following: clinical diagnosis of ASD, last date of continuous KPSC membership, death, or study end date (December 31, 2017).

Of 419,425 children (boys, 51%) meeting study criteria, 621 were exposed to maternal T1D, 9,453 to maternal T2D, 11,922 to GDM diagnosed by 26 weeks’ gestation, and 24,505 to GDM diagnosed after 26 weeks’ gestation.

During a median follow-up of 6.9 years (interquartile range, 3.4-11.9), 5827 children were diagnosed with ASD.

Cox regression was used to estimate hazard ratios (HRs) adjusting for potential confounders, which included birth year, maternal age at delivery, parity, education, self-reported race/ethnicity, median family household income based on residence census tract, history of comorbidity (≥1 diagnosis of heart, lung, kidney, or liver disease; cancer), and child’s sex.

Relative to no diabetes exposure, the adjusted HRs for exposure to maternal diabetes were 2.36 (95% CI, 1.36-4.12) for T1D, 1.45 (95% CI, 1.24-1.70) for T2D, 1.30 (95% CI, 1.12-1.51) for GDM by 26 weeks’ gestation, and 0.99 (95% CI, 0.88-1.12) for GDM after 26 weeks.

Additional adjustment for maternal smoking during pregnancy and pre-pregnancy BMI changed results only slightly.

Confounding due to paternal risk factors and other intrauterine and postnatal exposures could not be assessed.

Risks were not statistically significantly different between those with vs without antidiabetic medication exposure during pregnancy within the GDM group (adjusted HR, 1.18 [95% CI, 0.97-1.43]; P = .10).

Among the three main types of diabetes complicating pregnancy, the risk of ASD in offspring was elevated in mothers with T1D, T2D, and GDM diagnosed by 26 weeks’ gestation compared with no diabetes, the authors conclude.

These results add new information on T1D and extend previous findings for pre-existing T2D and GDM.

However GDM diagnosed after 26 weeks’ gestation was not associated with excess risk compared with no diabetes.

This suggests that “the severity of maternal diabetes and the timing of exposure (early vs late in pregnancy) may be associated with the risk of ASD in offspring of diabetic mothers,” say the researchers.

“The potential role of maternal glycemia; other features of T1D such as autoimmunity and genetic factors; prematurity; and neonatal hypoglycemia remains to be explored.”

No conflicts of interest were reported by the authors. The work was partially supported by Kaiser Permanente Southern California Direct Community Benefit funds.

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