title: Maternal hospitalization with infection during pregnancy and risk of autism spectrum disorders.
abstract: Animal models indicate that maternal infection during pregnancy can result in behavioral abnormalities and neuropathologies in offspring. We examined the association between maternal inpatient diagnosis with infection during pregnancy and risk of ASD in a Swedish nationwide register-based birth cohort born 1984-2007 with follow-up through 2011. In total, the sample consisted of 2,371,403 persons with 24,414 ASD cases. Infection during pregnancy was defined from ICD codes. In the sample, 903 mothers of ASD cases (3.7%) had an inpatient diagnosis of infection during pregnancy. Logistic regression models adjusted for a number of covariates yielded odds ratios indicating approximately a 30% increase in ASD risk associated with any inpatient diagnosis of infection. Timing of infection did not appear to influence risk in the total Swedish population, since elevated risk of ASD was associated with infection in all trimesters. In a subsample analysis, infections were associated with greater risk of ASD with intellectual disability than for ASD without intellectual disability. The present study adds to the growing body of evidence, encompassing both animal and human studies, that supports possible immune-mediated mechanisms underlying the etiology of ASD.
authors.affiliation: Department of Epidemiology and Biostatistics, Drexel University School of Public Health, Philadelphia, PA, USA; A.J. Drexel Autism Institute, Philadelphia, PA, USA. Electronic address: bklee@drexel.edu.
authors.forename: Brian K
authors.initials: BK
authors.lastname: Lee
authors.affiliation: Division of Public Health Epidemiology, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Cecilia
authors.initials: C
authors.lastname: Magnusson
authors.affiliation: Division of Public Health Epidemiology, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden; Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Renee M
authors.initials: RM
authors.lastname: Gardner
authors.affiliation: Division of Public Health Epidemiology, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Åsa
authors.initials: Å
authors.lastname: Blomström
authors.affiliation: Department of Epidemiology and Biostatistics, Drexel University School of Public Health, Philadelphia, PA, USA; A.J. Drexel Autism Institute, Philadelphia, PA, USA.
authors.forename: Craig J
authors.initials: CJ
authors.lastname: Newschaffer
authors.affiliation: A.J. Drexel Autism Institute, Philadelphia, PA, USA; Department of Environmental and Occupational Health, Drexel University School of Public Health, Philadelphia, PA, USA.
authors.forename: Igor
authors.initials: I
authors.lastname: Burstyn
authors.affiliation: Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Håkan
authors.initials: H
authors.lastname: Karlsson
authors.affiliation: Division of Public Health Epidemiology, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Christina
authors.initials: C
authors.lastname: Dalman
mesh_terms: D000328:Adult; D002659:Child Development Disorders, Pervasive / Q000453:epidemiology* / Q000209:etiology* / Q000276:immunology / Q000382:microbiology; D015331:Cohort Studies; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000453:epidemiology* / Q000276:immunology / Q000382:microbiology; D012307:Risk Factors; D013548:Sweden / Q000453:epidemiology
keywords: Autism; Cytokines; Epidemiology; Infection