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Autism Spectrum Disorder Diagnoses and Congenital Cytomegalovirus
Megan H Pesch1, Jessica Leung2, Tatiana M Lanzieri2
1Division of Developmental and Behavioral Pediatrics, Department of Pediatrics, University of Michigan, Ann Arbor, Michigan.
Insights
Children diagnosed with congenital cytomegalovirus (cCMV) showed a higher likelihood of receiving an autism spectrum disorder (ASD) diagnosis. This association was observed in a large Medicaid claims data analysis.
Area of Science:
- Pediatric Health
- Infectious Diseases
- Neurodevelopmental Disorders
Background:
- Congenital cytomegalovirus (cCMV) is a common viral infection in newborns.
- Autism spectrum disorder (ASD) is a complex neurodevelopmental condition.
- The potential link between cCMV and ASD requires further investigation.
Purpose of the Study:
- To investigate the association between congenital cytomegalovirus (cCMV) and autism spectrum disorder (ASD) administrative diagnoses in US children.
- To analyze administrative claims data to identify children with cCMV and ASD.
Main Methods:
- A cohort study utilized Medicaid claims data from 2014 to 2020.
- Diagnosis codes identified cCMV (exposure) and ASD (outcome) in children aged 0 to 7 years.
- Cox proportional hazards regression models were employed to estimate hazard ratios, adjusting for covariates and stratifying by sex, birth outcomes, and central nervous system (CNS) anomalies.
Main Results:
- The study included nearly 3 million children, identifying 1044 with cCMV and over 74,000 with ASD.
- Children with cCMV demonstrated a 2.5-fold increased likelihood of ASD diagnosis (HR: 2.5; 95% CI: 2.0-3.2).
- The association between cCMV and ASD varied by sex and the presence of CNS anomalies.
Conclusions:
- Children with cCMV diagnoses in Medicaid claims data were significantly more likely to have ASD diagnoses.
- The findings suggest a potential link between cCMV and ASD, particularly in symptomatic cases.
- Further research using universal cCMV screening cohorts is recommended to clarify these associations.
Objective:
To examine the association between congenital cytomegalovirus (cCMV) and autism spectrum disorder (ASD) administrative diagnoses in US children.
Methods:
Cohort study using 2014 to 2020 Medicaid claims data. We used diagnosis codes to identify cCMV (exposure), ASD (outcome), and covariates among children enrolled from birth through ≥4 to <7 years. Covariates include central nervous system (CNS) anomaly or injury diagnosis codes, including brain anomaly, microcephaly within 45 days of birth, cerebral palsy, epilepsy, or chorioretinitis. We used Cox proportional hazards regression models to estimate hazard ratios and 95% confidence intervals, overall and stratified by sex, birth weight and gestational age outcome (low birth weight or preterm birth), and presence of CNS anomaly or injury.
Results:
Among 2 989 659 children, we identified 1044 (3.5 per 10 000) children with cCMV and 74 872 (25.0 per 1000) children with ASD. Of those with cCMV, 49% also had CNS anomaly or injury diagnosis codes. Children with cCMV were more likely to have ASD diagnoses (hazard ratio: 2.5; 95% confidence interval: 2.0-3.2, adjusting for birth year, sex, and region). This association differed by sex and absence of CNS anomaly or injury but not birth outcome.
Conclusions:
Children with (versus without) cCMV diagnoses in Medicaid claims data, most of whom likely had symptomatic cCMV, were more likely to have ASD diagnoses. Future research investigating ASD risk among cohorts identified through universal cCMV screening may help elucidate these observed associations.
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