June 27, 2018

A new study suggests that type 1 diabetes in pregnant women may contribute to their offspring’s risk of autism spectrum disorder (ASD).

Previous studies had shown that women with type 2 diabetes (T2D) or gestational diabetes mellitus (GDM) were more likely to have children with autism. But little has been known about autism risk associated with maternal type 1 diabetes (T1D).

The findings, published online June 23 in JAMA, were based on the health records of 419,425 children born between 1995 and 2012. Researchers found that the offspring’s autism risk was elevated in mothers with T1D, as well as those with T2D and GDM. A total of 5,827 children were diagnosed with ASD.

The study authors stressed that the findings did not prove that diabetes causes autism, only that the conditions appear to be linked.

“Autism is a complex disorder, but diabetes during pregnancy is one of the many risk factors associated with the condition,” says the lead study author, Anny H. Xiang, PhD, the director of biostatistics research at Kaiser Permanente in Pasadena, California.

Risk Increases Later in Pregnancy

The findings also suggest that autism risk varies depending on when maternal diabetes is diagnosed during the pregnancy.

According to the study, around 3 percent to 4 percent of children who developed autism had mothers diagnosed with diabetes within 26 weeks of pregnancy. However, GDM diagnosed after 26 weeks’ gestation was not associated with an increased autism risk.

“I think we may need to be very aggressive about controlling sugar during very early pregnancy, and that means that patients should come in [to their doctor] very early when they think they might be pregnant,” says Jennifer Wu, MD, an obstetrician and gynecologist at Lenox Hill Hospital in New York City.

Dr. Wu adds that blood sugar that is not well controlled in pregnant women with diabetes can lead to miscarriage or birth defects in the developing baby.

“We want to optimize diet and medical regimens early on in a pregnancy, or even before she becomes pregnant, so she can establish very good glucose control,” Wu says.

Dr. Xiang agrees that “although we don’t know what causes the increased [autism] risk, getting blood sugar under good control at preconception and throughout pregnancy is always important.”

Prevalence of Autism

According to the Centers for Disease Control and Prevention (CDC), about 1 out of 59 U.S. children is diagnosed with ASD. The number of autism diagnoses in this country jumped more than 150 percent from 2000 to 2014.

The American Psychiatric Association (APA) defines ASD as a complex developmental disorder that can cause problems with thinking, feeling, language, and the ability to relate to others. Its characteristics fall into three categories:

  • Communication problems
  • Difficulty relating to people, things, and events
  • Repetitive body movements or behaviors

The American Academy of Pediatrics recommends that developmental surveillance be part of every well-child preventive care visit and that screening tests be administered at the child’s 9-, 18-, and 24- or 30-month visits.

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