Anny H. Xiang
ORLANDO, Fla. — Children born to mothers with type 1 diabetes, type 2 diabetes or early-pregnancy gestational diabetes are more likely to receive an autism spectrum diagnosis compared with children born to mothers without diabetes in pregnancy, according to a speaker here.
In an analysis of more than 400,000 children born in southern California hospitals over 15 years, researchers also observed no association between gestational diabetes diagnosed after 26 weeks’ gestation and risk for autism spectrum diagnosis in offspring.
“I think most are familiar with the associations of diabetes during pregnancy with adverse pregnancy outcomes and child’s obesity and metabolic disorders later in life,” Anny H. Xiang, PhD, director of biostatistics research in the department of research and evaluation at Kaiser Permanente Southern California, Pasadena, told Endocrine Today at the American Diabetes Association Scientific Sessions. “The associations with neurodevelopmental disorders in children are less known.”
In a retrospective, longitudinal study, Xiang and colleagues analyzed electronic medical records data from 419,425 singleton children (51% boys) born at 28 to 44 weeks’ gestation from 1995 to 2012 at Kaiser Permanente Southern California hospitals. Children were tracked from birth until the first date of clinical diagnosis of autism spectrum disorder, death or Dec. 31, 2016. Researchers used Cox regressions models adjusted for birth year, maternal age, parity, education, household income, race, comorbidities and sex of child to estimate HRs for autism spectrum disorder diagnosis risk.
Within the cohort, 621 children were exposed to type 1 diabetes, 9,453 children were exposed to type 2 diabetes, whereas 11,922 children were exposed to gestational diabetes in utero diagnosed by 26 weeks’ gestation and 24,505 children were exposed to gestational diabetes diagnosed after 26 weeks’ gestation, Xiang said.
During a median of 6.9 years after birth, 5,827 children were diagnosed with autism spectrum disorder. Of those children, 19 were exposed to type 1 diabetes, 233 were exposed to type 2 diabetes, 253 were exposed to gestational diabetes by 26 weeks’ gestation and 372 were exposed to gestational diabetes diagnosed after 26 weeks’ gestation.
Compared with no exposure to maternal diabetes, the adjusted HRs for risk for an autism spectrum diagnosis were 2.36 for exposure to maternal type 1 diabetes (95% CI, 1.34-4.12) 1.45 for exposure to maternal type 2 diabetes (95% CI, 1.24-1.7), 1.3 for exposure to gestational diabetes diagnosed before 26 weeks’ gestation (95% CI, 1.12-1.51) and 0.99 for exposure to gestational diabetes diagnosed after 26 weeks’ gestation (95% CI, 0.88-1.12).
“The results suggest that the severity of maternal diabetes and the timing of exposure may be associated with the risk for autism spectrum disorder,” Xiang said during her presentation. “The potential role of maternal glycemia, other features of type 1 diabetes, prematurity and neonatal hypoglycemia remain to be explored.”
Xiang said the rising rates of maternal diabetes may be one factor contributing to rising rates of autism spectrum disorder in children. The findings were simultaneously published in a research letter in JAMA. – by Regina Schaffer
Xiang A, et al. 117-OR. Presented at: American Diabetes Association 78th Scientific Sessions; June 22-26, 2018; Orlando, Fla.
Xiang A, et al. JAMA. 2018; doi:10.1001/jama.2018.7614.
Disclosures: Xiang reports no relevant financial disclosures.