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Maternal type 1 diabetes, pre-term birth and risk of autism spectrum disorder-a prospective cohort study

Martina Persson1,2,3, Abraham Reichenberg2,3, Mikael Andersson Franko1,4

  • 1Department of Clinical Science and Education, Division of Pediatrics, Karolinska Institutet, Stockholm, Sweden.

International Journal of Epidemiology
|June 3, 2022
PubMed

Insights

Maternal type 1 diabetes (T1D) is linked to a higher risk of autism spectrum disorder (ASD) in children. Pre-term birth accounts for a significant portion of this increased risk, while HbA1c levels did not show an independent association.

Area of Science:

  • Reproductive Health
  • Pediatric Neurology
  • Endocrinology

Background:

  • Maternal type 1 diabetes (T1D) is a known risk factor for adverse pregnancy outcomes.
  • The association between maternal T1D and autism spectrum disorder (ASD) in offspring requires further investigation.
  • The mediating role of pre-term birth and the impact of maternal glycated haemoglobin (HbA1c) levels remain unclear.

Purpose of the Study:

  • To investigate the association between maternal T1D and ASD risk in offspring.
  • To determine the extent to which pre-term birth mediates this association.
  • To assess the impact of maternal HbA1c levels on ASD risk in offspring of mothers with T1D.

Main Methods:

  • A large-scale cohort study of 1.4 million Swedish children born between 1998 and 2015.
  • Utilized national registers to obtain data on maternal T1D, HbA1c, pre-term birth, and offspring ASD diagnoses.
  • Employed Cox regression and log-binomial regression to estimate relative risks (RR) and hazard ratios (HR).

Main Results:

  • Offspring of mothers with T1D had an increased risk of ASD (HR = 1.40).
  • Pre-term birth mediated approximately 22% of the T1D-associated ASD risk (RR = 1.06).
  • Maternal HbA1c levels were not independently associated with ASD risk beyond the T1D diagnosis itself.

Conclusions:

  • Maternal T1D is associated with an elevated risk of ASD in offspring.
  • Pre-term birth is a significant contributing factor to the increased ASD risk in this population.
  • Clinical awareness and management of T1D pregnancies should consider the heightened risk of ASD, particularly when pre-term birth is a concern.
Abstract

Keywords:
Autismaetiologycohortepidemiologymediationpre-term birthtype 1 diabetes

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