Cross-Setting Replication of the Associations Between Maternal Health and Autism

Autism spectrum disorder (ASD) is a neurodevelopmental condition with early-life origins. Maternal health conditions during pregnancy have been linked to autism risk, but most studies have focused on single populations, thus limiting generalizability. We examined whether associations previously reported in a Danish registry-based study were similar in a US cohort.

We analyzed electronic health records of children born between 2010 and 2017 at Kaiser Permanente Northern California (KPNC), along with their mothers. Maternal diagnoses were classified as chronic or non-chronic. Associations with ASD in the child were assessed using Cox models, adjusting for sociodemographic factors, health care use, and comorbid maternal diagnoses. Methods were aligned with the Danish study for comparability.

Among 224,353 children in the KPNC cohort, 5,448 (2.4%) were diagnosed with autism. Of the 42 maternal diagnoses significantly associated with autism in Denmark, 38 were evaluable in KPNC, and 18 remained statistically significant after adjustment. Most associations had point estimates consistent with the Danish study, particularly psychiatric and cardiometabolic conditions.

Despite demographic and health care differences, 35 of the 38 associations found in the Danish study replicated qualitatively (direction of effect) in the US cohort, suggesting robust cross-setting relevance. Further research is needed to explore underlying mechanisms and effect modifiers.

Research suggests certain maternal health problems during pregnancy may be linked to autism, but differing study methods makes it hard to know if results are consistent across different populations. This study analyzed electronic health records of 224,353 children born between 2010 and 2017 (2.4% of whom received an autism diagnosis) at Kaiser Permanente Northern California. The authors compared these results with a study done in Denmark using similar methods. Results showed that a number of maternal conditions, particularly psychiatric and cardiometabolic conditions, were associated with autism in their children in both studies, suggesting these links are not due to location-specific factors.