Gestational diabetes

Autism risk in children of mothers with diabetes

The severity of maternal diabetes and the timing of exposure – early versus late pregnancy – may be associated with the risk of autism spectrum disorder (ASD) in children of mothers with diabetes.

According to a large retrospective study of more than 419,000 singleton births presented at the ADA 78th Scientific Sessions, a diagnosis of type 1 diabetes in the mother was associated with a 2.36 fold increased  risk of ASD in the child.

The findings, published concurrently in JAMA, extend earlier results of an association with ASD and intrauterine exposure to maternal type 2 diabetes and gestational diabetes.

The children were born between 1995 and 2012 and tracked through electronic health records until diagnosis of ASD, death or the end of the study in December 2017.

Researcher Dr Anny Xiang, from Kaiser Permanente Southern California and the University of Southern California Los Angeles, told the meeting that type 2 diabetes in the mothers was associated with a 1.45 fold risk of ASD in the child.

Gestational diabetes diagnosed in the first 26 weeks of pregnancy was associated with a 1.30 risk of ASD in the child.

There was no additional risk of ASD in children of mothers diagnosed with gestational diabetes later than 26 weeks into their pregnancy.

The findings were adjusted for multiple confounders including maternal age, parity, birth year, race, maternal education, household income, comorbidities and gender of the children.

All mothers with type 1 or type 2 diabetes and about 29% of mother with gestational diabetes were dispensed diabetes medications during their pregnancy.

No relationship was observed between risk of ASD and diabetes medications within the gestational diabetes group.

“These results suggest 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,” the researchers concluded.

Dr Xiang said the potential role of maternal glycaemia and other features of type 1 diabetes such as autoimmunity and genetic factors, prematurity and neonatal hypoglycaemia remain to be explored.

The study provided no data on confounding due to paternal risk factors and other intrauterine and postnatal exposures such as breastfeeding.

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