In utero exposure to maternal obesity and diabetes has been associated with risk of autism spectrum disorders (ASD) in children. As early identification and support improves long-term outcomes in children with ASD, a 10-point Quantitative Checklist for Autism in Toddlers (QCHAT) screening questionnaire was developed and validated for clinical screening between 18-24 months at well-child visits. This study assessed associations between maternal metabolic exposures and offspring performance on early QCHAT screening. Data included 65699 singletons born in a single healthcare system, with QCHAT administered toddler well-child visits. Demographic and social data, maternal pregnancy obesity (BMI≥30 kg/m2) , pre-existing type 1/type 2 (T1D/T2D) , and gestational diabetes (GDM) status, and child’s QCHAT score were extracted from electronic medical records. Negative binomial regression was used to assess associations between maternal obesity and diabetes and QCHAT scores as a continuous measure, adjusting for covariates. Analyses included and excluded children with ASD diagnoses and were run with and without mutual adjustment for each metabolic condition. In this cohort, 18923 (28.8%) of children were exposed to maternal obesity, 2564 (3.9%) to T1/T2, 1946 (3.0%) to GDM diagnosed at ≤26 weeks, and 3290 (5.0%) GDM diagnosed >26 weeks. Of the total cohort, 1622 (2.5%) were later diagnosed with ASD. Maternal obesity (Incidence Rate Ratio: 1.12, 95% CI: 1.09,1.14) , T1D/T2D (1.13, 1.07-1.20) , and GDM ≤26 weeks (1.12, 1.05-1.19) were associated with one-unit increases in QCHAT scores. No associations were reported for GDM >26 weeks. Similar patterns were observed after excluding children with ASD diagnoses. Mutual adjustment did not change results. These data suggest maternal metabolic conditions during pregnancy are associated with increased social and communication impairment on early autism screening tools, even in typically developing children.


S.A.Carter: None. J.C.Lin: None. T.Chow: None. M.P.Martinez: None. J.M.Alves: None. R.Feldman: None. C.Qiu: None. K.A.Page: None. A.Xiang: None.

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