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Maternal Pre-pregnancy Body Mass Index and Autism Spectrum Disorder among Offspring: A Population-Based Case-Control
Kelly D Getz1, Marlene T Anderka2, Martha M Werler1
1Boston University School of Public Health, Boston, MA.
Insights
Maternal underweight and obesity are linked to a modest increase in autism spectrum disorder (ASD) risk. This study explored maternal pre-pregnancy body mass index (BMI) and its association with ASD occurrence.
Area of Science:
- Reproductive Health
- Pediatric Neurology
- Epidemiology
Background:
- Previous research linked high maternal weight gain and obesity to increased autism spectrum disorder (ASD) risk.
- Maternal underweight has not been previously investigated concerning ASD risk.
Purpose of the Study:
- To investigate the association between maternal pre-pregnancy body mass index (BMI) and the occurrence of ASD in singletons.
- To explore the non-linear relationship between maternal BMI and ASD risk.
Main Methods:
- Utilized the General Practice Research Database (1993-2008) for singleton births.
- Matched ASD cases with up to four controls based on birth year, sex, and general practice.
- Employed conditional logistic regression and restricted cubic splines to analyze BMI categories (underweight, normal, overweight, obese) and non-linear associations.
Main Results:
- The association between maternal BMI and ASD occurrence exhibited a non-linear, J-shaped pattern.
- Maternal underweight (adjusted OR 1.43) and obesity (adjusted OR 1.54) were associated with increased ASD risk compared to normal weight.
Conclusions:
- Extremes in maternal pre-pregnancy BMI (both underweight and obesity) may be associated with modest increases in offspring's ASD risk.
- Findings highlight the importance of considering maternal BMI in ASD risk assessment.
Background:
Previous studies have attributed high maternal weight gain during pregnancy and pre-pregnancy obesity to a higher risk for autism spectrum disorder (ASD). Maternal underweight was not previously explored with respect to ASD risk.
Methods:
We evaluated the association between maternal pre-pregnancy body mass index (BMI) and ASD occurrence among singletons born into the General Practice Research Database from 1993 to 2008. Case subjects were children with a diagnosis of ASD from birth to 2010. Up to four control subjects were matched to each case subject on birth year, sex, and general practice. Restricted cubic splines were used to assess the non-linearity of the association between maternal BMI and ASD. All study subjects were classified as underweight, normal weight, overweight, or obese based on maternal pre-pregnancy BMI using the WHO Classification Standard. Conditional logistic regression was used to calculate unadjusted and multivariable adjusted odds ratios for the association between categorical BMI (reference=normal weight) and the occurrence of ASD.
Results:
The association between maternal BMI and ASD occurrence was non-linear and J-shaped. The adjusted ORs for maternal underweight and obesity were 1.43 (95% CI 1.01, 2.04) and 1.54 (95% CI 1.26, 1.89) respectively.
Conclusions:
Results suggest that extremes in maternal BMI may be associated with modest increases in the risk for ASD among offspring.
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