• Mengying Li, M Daniele Fallin, Anne Riley, Rebecca Landa, Sheila O Walker, Michael Silverstein, Deanna Caruso, Colleen Pearson, Shannon Kiang, Jamie Lyn Dahm, Xiumei Hong, Guoying Wang, Mei-Cheng Wang, Barry Zuckerman, and Xiaobin Wang.
• Departments of Population, Family, and Reproductive Health.
• Pediatrics. 2016 Feb 1; 137 (2): e20152206.

BackgroundObesity and diabetes are highly prevalent among pregnant women in the United States. No study has examined the independent and combined effects of maternal prepregnancy obesity and maternal diabetes on the risk of autism spectrum disorder (ASD) in parallel with other developmental disorders (DDs).MethodsThis study is based on 2734 children (including 102 ASD cases), a subset of the Boston Birth Cohort who completed at least 1 postnatal study visit at Boston Medical Center between 1998 and 2014. Child ASD and other DDs were based on physician diagnoses as documented in electronic medical records. Risks of ASD and other DDs were compared among 6 groups defined by maternal prepregnancy obesity and diabetes status by using Cox proportional hazard regression controlling for potential confounders.ResultsWhen examined individually, maternal prepregnancy obesity and pregestational diabetes (PGDM) were each associated with risk of ASD. When examined in combination, only mothers with obesity and PGDM (hazard ratio 3.91, 95% confidence interval 1.76-8.68) and those with obesity and gestational diabetes (hazard ratio 3.04, 95% confidence interval 1.21-7.63) had a significantly increased risk of offspring ASD. Intellectual disabilities (IDs), but not other DDs, showed a similar pattern of increased risk associated with combined obesity and PGDM. This pattern of risk was mostly accounted for by cases with co-occurring ASD and ID.ConclusionsMaternal prepregnancy obesity and maternal diabetes in combination were associated with increased risk for ASD and ID. ASD with ID may be etiologically distinct from ASD without ID.Copyright © 2016 by the American Academy of Pediatrics.

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