Study is one of the largest and most ethnically diverse to look at maternal diabetes as a risk factor for autism.
PASADENA, Calif. — Children whose mothers developed gestational diabetes by the 26th week of pregnancy were at increased risk of developing autism later in life, according to a new Kaiser Permanente study published today in the Journal of the American Medical Association.
Researchers examined the electronic health records of more than 322,000 ethnically diverse children born between 28 and 44 weeks at Kaiser Permanente Southern California medical centers between January 1995 and December 2009. They followed the children for an average of 5.5 years and found that those exposed to gestational diabetes by the 26th week of pregnancy had a 63 percent increased risk of being diagnosed with an autism spectrum disorder than children who were not exposed. After taking into account maternal age, education, race and ethnicity, household income and other factors, the increased risk of autism associated with gestational diabetes was 42 percent.
“The exposure of fetuses to maternal hyperglycemia may have long-lasting effects on organ development and function, but whether this can disrupt fetal brain development and heighten risk for neurobehavioral developmental disorders in offspring is less clear,” said study lead author Anny H. Xiang, PhD, of the Kaiser Permanente Southern California Department of Research & Evaluation. “Future studies should address whether early diagnosis and treatment of gestational diabetes can reduce the risk of autism.” She noted that this was an observational study, therefore the findings reveal associations between gestational diabetes and risk of a child developing autism rather than proving a cause and effect relationship.
The study also found that children whose mothers developed gestational diabetes after 26 weeks of pregnancy had no more risk of autism spectrum disorder than children whose mothers did not have preexisting diabetes or gestational diabetes.
“If the findings of this study reflect a cause and effect relationship, then they add another factor to a growing list of risks associated with gestational diabetes," said study co-author Edward S. Curry, MD, pediatric learning and behavior specialist, Kaiser Permanente Fontana Medical Center. “Our study findings also suggest that early screening for autism in children of women with gestational diabetes diagnosed by 26 weeks gestation may be warranted."
Autism spectrum disorder is a group of developmental disabilities that can cause significant social, communication and behavioral challenges, according to the Centers for Disease Control and Prevention. People with autism spectrum disorders may communicate, interact, behave and learn in ways that are different from other people and can range from gifted to severely challenged. About 1 in 68 children have been identified with autism spectrum disorder, according to estimates from CDC's Autism and Developmental Disabilities Monitoring Network.
Gestational diabetes is a type of diabetes that develops or is first recognized during pregnancy. While the true prevalence of gestational diabetes is unknown and varies based on diagnostic criteria used, a recent study from the CDC indicated that rates could be as high as 9.2 percent. Gestational diabetes can also lead to additional health problems for the mother, including an increased risk of developing type 2 diabetes and a greater likelihood of delivering a large baby.
This research is part of Kaiser Permanente’s continuing efforts to address health issues related to pregnancy. Last October, a Kaiser Permanente study found that women who developed gestational diabetes and were overweight before pregnancy were at a higher risk of having daughters who were obese later in childhood. And last May, Kaiser Permanente researchers found that women with high levels of a common liver enzyme measured prior to pregnancy were twice as likely to subsequently develop gestational diabetes as those with the lowest levels.
Other authors of the paper include Xinhui Wang, MS, Mayra P. Martinez, MPH, and Karen J. Coleman, PhD, of the Kaiser Permanente Southern California Department of Research & Evaluation; Johanna C. Walthall, PhD, of the Kaiser Permanente Southern California Department of Psychiatry; Kathleen Page, MD, and Thomas A. Buchanan, MD, of the Division of Endocrinology and Diabetes, Department of Medicine, Keck School of Medicine of the University of Southern California; and Darios Getahun, MD, PhD, of the Kaiser Permanente Southern California Department of Research & Evaluation and Department of Obstetrics & Gynecology, Rutgers-Robert Wood Johnson Medical School.
The Department of Research & Evaluation conducts high-quality, innovative research into disease etiology, prevention, treatment and care delivery. Investigators conduct epidemiology, health sciences and behavioral research as well as clinical trials. Areas of interest include diabetes and obesity, cancer, HIV/AIDS, cardiovascular disease, aging and cognition, pregnancy outcomes, women’s and children’s health, quality and safety, and pharmacoepidemiology. Located in Pasadena, California, the department focuses on translating research to practice quickly to benefit the health and lives of Kaiser Permanente Southern California members and the general population. Visit kp.org/research.
Kaiser Permanente is committed to helping shape the future of health care. We are recognized as one of America’s leading health care providers and not-for-profit health plans. Founded in 1945, Kaiser Permanente has a mission to provide high-quality, affordable health care services and to improve the health of our members and the communities we serve. We currently serve approximately 9.6 million members in eight states and the District of Columbia. Care for members and patients is focused on their total health and guided by their personal physicians, specialists and team of caregivers. Our expert and caring medical teams are empowered and supported by industry-leading technology advances and tools for health promotion, disease prevention, state-of-the-art care delivery and world-class chronic disease management. Kaiser Permanente is dedicated to care innovations, clinical research, health education and the support of community health.