title: The Association of Maternal Obesity and Diabetes With Autism and Other Developmental Disabilities.
abstract: BACKGROUND
  Obesity and diabetes are highly prevalent among pregnant women in the United States. No study has examined the independent and combined effects of maternal prepregnancy obesity and maternal diabetes on the risk of autism spectrum disorder (ASD) in parallel with other developmental disorders (DDs).
  
  
  METHODS
  This study is based on 2734 children (including 102 ASD cases), a subset of the Boston Birth Cohort who completed at least 1 postnatal study visit at Boston Medical Center between 1998 and 2014. Child ASD and other DDs were based on physician diagnoses as documented in electronic medical records. Risks of ASD and other DDs were compared among 6 groups defined by maternal prepregnancy obesity and diabetes status by using Cox proportional hazard regression controlling for potential confounders.
  
  
  RESULTS
  When examined individually, maternal prepregnancy obesity and pregestational diabetes (PGDM) were each associated with risk of ASD. When examined in combination, only mothers with obesity and PGDM (hazard ratio 3.91, 95% confidence interval 1.76-8.68) and those with obesity and gestational diabetes (hazard ratio 3.04, 95% confidence interval 1.21-7.63) had a significantly increased risk of offspring ASD. Intellectual disabilities (IDs), but not other DDs, showed a similar pattern of increased risk associated with combined obesity and PGDM. This pattern of risk was mostly accounted for by cases with co-occurring ASD and ID.
  
  
  CONCLUSIONS
  Maternal prepregnancy obesity and maternal diabetes in combination were associated with increased risk for ASD and ID. ASD with ID may be etiologically distinct from ASD without ID.
authors.affiliation: Departments of Population, Family, and Reproductive Health.
authors.forename: Mengying
authors.initials: M
authors.lastname: Li
authors.affiliation: Mental Health, and.
authors.forename: M Daniele
authors.initials: MD
authors.lastname: Fallin
authors.affiliation: Departments of Population, Family, and Reproductive Health.
authors.forename: Anne
authors.initials: A
authors.lastname: Riley
authors.affiliation: Kennedy Krieger Institute, Baltimore, Maryland; Departments of Psychiatry and Behavioral Sciences, and.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Landa
authors.affiliation: Departments of Population, Family, and Reproductive Health.
authors.forename: Sheila O
authors.initials: SO
authors.lastname: Walker
authors.affiliation: Department of Pediatrics, Boston University Medical Center, Boston, Massachusetts.
authors.forename: Michael
authors.initials: M
authors.lastname: Silverstein
authors.affiliation: Departments of Population, Family, and Reproductive Health.
authors.forename: Deanna
authors.initials: D
authors.lastname: Caruso
authors.affiliation: Department of Pediatrics, Boston University Medical Center, Boston, Massachusetts.
authors.forename: Colleen
authors.initials: C
authors.lastname: Pearson
authors.affiliation: Department of Pediatrics, Boston University Medical Center, Boston, Massachusetts.
authors.forename: Shannon
authors.initials: S
authors.lastname: Kiang
authors.affiliation: Mental Health, and.
authors.forename: Jamie Lyn
authors.initials: JL
authors.lastname: Dahm
authors.affiliation: Departments of Population, Family, and Reproductive Health.
authors.forename: Xiumei
authors.initials: X
authors.lastname: Hong
authors.affiliation: Departments of Population, Family, and Reproductive Health.
authors.forename: Guoying
authors.initials: G
authors.lastname: Wang
authors.affiliation: Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland;
authors.forename: Mei-Cheng
authors.initials: MC
authors.lastname: Wang
authors.affiliation: Department of Pediatrics, Boston University Medical Center, Boston, Massachusetts.
authors.forename: Barry
authors.initials: B
authors.lastname: Zuckerman
authors.affiliation: Departments of Population, Family, and Reproductive Health, Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland; and xwang82@jhu.edu.
authors.forename: Xiaobin
authors.initials: X
authors.lastname: Wang
mesh_terms: D000293:Adolescent; D000067877:Autism Spectrum Disorder / Q000175:diagnosis / Q000209:etiology*; D001900:Boston; D002648:Child; D002675:Child, Preschool; D002658:Developmental Disabilities / Q000175:diagnosis / Q000209:etiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D009765:Obesity; D011247:Pregnancy; D011248:Pregnancy Complications; D011254:Pregnancy in Diabetics; D011297:Prenatal Exposure Delayed Effects / Q000175:diagnosis / Q000209:etiology*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors
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