New data have demonstrated an association between exposure to gestational diabetes diagnosed by 26 weeks’ gestation and risk for autism spectrum disorders (ASDs).
“The exposure of fetuses to maternal hyperglycemia may have long-lasting effects on organ development and function, but whether this can disrupt fetal brain development and heighten risk for neurobehavioral developmental disorders in offspring is less clear,” lead study author Anny H. Xiang, PhD, of the Kaiser Permanente Southern California Department of Research & Evaluation, said in a press release.
In the study, which was recently published in JAMA, researchers analyzed data from 322,323 children born between 1995 and 2009 at Kaiser Permanente Southern California (KPSC) hospitals. The children were tracked from birth until date of clinical diagnosis of ASD, last date of continuous KPSC health plan membership, death due to any cause or Dec. 31, 2012.
Of all children included in the study, 6,496 (2%) were exposed to preexisting type 2 diabetes, 25,035 (7.8%) were exposed to gestational diabetes and 290,792 (90.2%) were unexposed.
Results showed that 3,388 children were diagnosed with ASD after a median of 5.5 years. Of these children, 115 were exposed to preexisting type 2 diabetes, 130 were exposed to gestational diabetes diagnosed at 26 weeks or earlier, 180 were exposed to gestational diabetes diagnosed at later than 26 weeks and 2,963 were not exposed to type 2 diabetes or gestational diabetes.
The birth-year adjusted HRs were 1.59 (95% CI, 1.29-1.95) for preexisting type 2 diabetes, 1.63 (95% CI, 1.35-1.97) for gestational diabetes diagnosed at 26 weeks or earlier and 0.98 (95% CI, 0.84-1.15) for gestational diabetes diagnosed after 26 weeks, the researchers reported.
After adjustment for maternal age, parity, education, household income, race/ethnicity, history of comorbidity and sex of the child, gestational diabetes diagnosed at 26 weeks or earlier was significantly associated with risk for ASD (HR=1.42; 95% CI, 1.15-1.74), but maternal preexisting type 2 diabetes was not (HR=1.21; 95% CI, 0.97-1.52).
Exposure to antidiabetic medication was not independently associated with risk for ASD, according to the data. Results were also not affected by adjustment for a mother or older sibling with ASD in the full cohort, or adjustment for maternal smoking, prepregancy BMI and gestational weight gain in the subset with available data.
“Future studies should address whether early diagnosis and treatment of gestational diabetes can reduce the risk of autism,” Xiang said, noting that this study was observational and therefore does not prove a cause-and-effect relationship between gestational diabetes and risk for ASD.
“If the findings of this study reflect a cause-and-effect relationship, then they add another factor to a growing list of risks associated with gestational diabetes,” study co-author Edward S. Curry, MD, pediatric learning and behavior specialist, Kaiser Permanente Fontana Medical Center, said in the release.
“Our study findings also suggest that early screening for autism in children of women with gestational diabetes diagnosed by 26 weeks gestation may be warranted.”