Children exposed in utero to maternal type 2 diabetes (T2D) or gestational diabetes (GDM) diagnosed by 26 weeks gestation are at increased risk of autism spectrum disorders (ASD). Here we assessed the association between ASD and in utero exposure to maternal type 1 diabetes (T1D). Data were from 419,425 singleton children born at 28-44 weeks’ gestation from 1995-2012 at Kaiser Permanente Southern California (KPSC) hospitals. Children were tracked from birth until the first of the following: date of clinical diagnosis of ASD, last date of continuous KPSC membership, death due to any cause, or December 31, 2016. Relative risks of ASD were estimated by hazard ratio (HR) using Cox regression models adjusted for birth year, maternal age, parity, education, household income, race/ethnicity, history of comorbidity, and sex of the child. A total of 621 children were exposed to T1D, 9,453 to T2D, 11,922 to GDM diagnosed by 26 weeks gestation, and 24,5to GDM diagnosed after 26 weeks gestation. During a median of 6.3 (interquartile range of 3.4-11.2) years after birth, 5,624 children were diagnosed with ASD (19 exposed to T1D, 221 to T2D, 250 to GDM by 26 weeks, 360 to GDM after 26 weeks, and 4,774 not exposed to maternal diabetes). Unadjusted annual ASD incidence rates per 1000 children were 4.7 (T1D), 3.7 (T2D), 3.1 GDM by 26 weeks, 2.2 (GDM after 26 weeks) and 1.9 (unexposed). Relative to no diabetes exposure, the adjusted HRs for exposure to maternal diabetes were 2.5 (95% CI, 1.4-4.4) for T1D, 1.5 (95% CI, 1.3-1.7) for T2D, 1.4 (95% CI, 1.2-1.6) for GDM by 26 weeks, and 1.0 (95% CI, 0.9-1.1) for GDM after 26 weeks gestation respectively. Thus, exposures to T1D, T2D and GDM diagnosed by 26 weeks gestation were all associated with an increased risk of autism spectrum disorders in offspring. Exposure to T1D imparted the highest risk, followed by exposure to T2D and GDM diagnosed by 26 weeks. Rising rates of maternal diabetes may be one factor contributing to rising rates of ASD.


A. Xiang: None. X. Wang: None. M.P. Martinez: None. K.A. Page: None. T.A. Buchanan: None.

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