番茄社区

ORLANDO -- Maternal diabetes may increase autism risk among offspring, researchers reported here.

Compared with mothers without diabetes, in utero exposure to the main diabetes types -- type 1, type 2, or gestational diabetes mellitus (GDM) -- was tied to a heightened risk for autism spectrum disorder (ASD) in the offspring, according to Anny H. Xiang, PhD, of the Southern California Permanente Medical Group in Pasadena, and colleagues:

• Type 1 diabetes: adjusted HR 2.36 (95% CI 1.36-4.12, P=0.003)
• Type 2 diabetes: aHR 1.45 (95% CI 1.24-1.70, P<0.001)
• GDM at ≤26 weeks: aHR 1.30 (95% CI 1.12-1.51, P<0.001)

GDM diagnosed after 26 weeks of gestation was not linked to a significant increased for ASD, however (aHR 0.99, 95% CI 0.88-1.12, P=0.89). And interestingly, this associated risk was not significantly different among mothers with GDM on antidiabetic medications compared to those not on medication (aHR 1.18, 95% CI 0.97-1.43, P=0.10), they reported at the American Diabetes Association annual meeting and in the .

"We weren't surprised that there was an association between type 1 diabetes and autism, based on our prior work on type 2 diabetes and gestational diabetes. But we hadn't anticipated the greater magnitude of risk associated with type 1 diabetes," Xiang explained to 番茄社区. "While we haven't proven that good glucose control will reduce the risk of autism, the association we identified with autism is one of the many reasons to ensure good glycemia control prior to conception and continued during pregnancy" she added.

The retrospective cohort analysis assessed outcomes on 419,425 children. This included 621 children exposed to maternal type 1 diabetes, 19 of whom were diagnosed with ASD. There were 9,453 offspring exposed to maternal type 2 diabetes, with 233 cases of ASD. A total of 11,922 offspring were exposed to gestational diabetes that was diagnosed by week 26 of gestation, with 253 subsequent cases of ASD.

The children were then tracked through their electronic health records for a median of nearly 7 years. An ASD diagnoses included autistic disorders, Asperger syndrome, as well as pervasive developmental disorder not otherwise specified.

Even after further adjustment for prepregnancy maternal BMI and smoking status, these associations remained significant.

Study limitations included the inability to control for any paternal risk factors, or other intrauterine exposures, beyond diabetes that may have played a role on ASD risk.

Based upon these findings, Xiang suggested clinicians take note of this potential risk in order to take proactive measures. "Parents and care providers should be aware of the risk. Screening for autism risk for children born to mothers with type 1, type 2 and gestational diabetes diagnosed early during pregnancy may be warranted for early intervention," she recommended.

Comment