Maternal Thyroid Hormone Imbalance and Risk of Autism Spectrum Disorder
Leena Elbedour1, May Weinberg2,3, Gal Meiri4,5
1Department of Epidemiology, Biostatistics and Community Health Sciences, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 8410501, Israel.
Insights
Maternal hypothyroidism during pregnancy increases offspring autism spectrum disorder (ASD) risk, especially with persistent hormonal imbalance. Adequately treated hypothyroidism does not appear to elevate ASD risk.
Area of Science:
- Neurodevelopmental Disorders
- Endocrinology
- Pregnancy Health
Background:
- Maternal thyroid hormones are critical for fetal neurodevelopment.
- Gestational thyroid dysfunction is linked to atypical neurodevelopment and increased autism spectrum disorder (ASD) risk.
Purpose of the Study:
- To investigate the association between maternal thyroid dysfunction during pregnancy and the risk of ASD in offspring.
Main Methods:
- Retrospective cohort study including 51,296 singleton births.
- Data linked to electronic health records from a tertiary hospital in Israel.
- Offspring ASD diagnosis based on DSM-5 criteria.
Main Results:
- Maternal hypothyroidism persisting across multiple trimesters showed a dose-response relationship with increased ASD risk.
- Chronic hypothyroidism, if adequately treated, was not significantly associated with higher ASD risk.
- A total of 8.6% of mothers exhibited abnormal thyroid function during the study period.
Conclusions:
- Persistent maternal thyroid hormonal imbalance during pregnancy elevates offspring ASD risk.
- Adequately treated chronic hypothyroidism does not appear to be a risk factor for ASD.
- Routine thyroid function screening and prompt treatment during pregnancy are crucial for optimizing neurodevelopmental outcomes.
Context:
Maternal thyroid hormones are essential for fetal neurodevelopment. Gestational thyroid imbalance has been associated with atypical neurodevelopment, including increased risk of autism spectrum disorder (ASD).
Objective:
To examine the association between maternal thyroid dysfunction and ASD risk in offspring.
Design:
Retrospective cohort study with follow-up through January 2021.
Setting:
Single tertiary hospital in southern Israel (Soroka University Medical Center); linked to Clalit Health Services electronic records.
Patients Or Other Participants:
A total of 51 296 singleton births between January 2011 and December 2017.
Intervention(S):
None.
Main Outcome Measure(S):
Offspring ASD diagnosis (Diagnostic and Statistical Manual of Mental Disorders, fifth edition).
Results:
A total of 4409 (8.6%) of the mothers showed abnormal thyroid function. ASD cumulative incidence was similar in the offspring of women with normal and abnormal thyroid function (log-rank P = .27). While chronic hypothyroidism only (reflecting likely adequate treatment) was not significantly associated with ASD [adjusted hazard ratio (aHR), 0.47; 95% confidence interval (CI), 0.15-1.48], combined chronic and gestational hypothyroidism was associated with higher ASD risk (aHR, 2.61; 95% CI, 1.44-4.74). Trimester-specific analysis indicated a dose-response effect, in which the longer the period of hypothyroidism, the higher the ASD risk, namely, for 1, 2, or 3 trimesters of exposure: aHR, 1.69 (95% CI, 1.19-2.83); aHR, 2.39 (95% CI, 1.24-5.78); aHR, 3.25 (95% CI, 1.07-7.21), respectively.
Conclusion:
The findings suggest adequately treated chronic hypothyroidism is not associated with ASD in offspring, whereas persistent hormonal imbalance across trimesters conveys elevated risk. These findings underscore the importance of routine thyroid function screening and timely treatment throughout pregnancy.
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