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A study of 224,353 children in Kaiser Permanente Northern California found maternal health conditions during pregnancy were associated with autism across racial and ethnic groups. Associations for maternal overweight or obesity, depression, asthma and pregnancy complications were stronger among white mothers; the researchers said the reasons for those differences remain uncertain.
A study of 224,353 children born from 2010 to 2017 found that maternal health conditions during pregnancy were associated with autism across racial and ethnic groups, while four associations were stronger among white mothers. The findings, reported by researchers led by Magdalena Janecka of NYU Grossman School of Medicine in JAMA Network Open, point to differences that may affect how maternal conditions and autism are identified and studied.
Researchers used health system records to examine 25 maternal diagnoses previously linked to autism. Of the children in the study, 5,448 were diagnosed with autism; their mean age at diagnosis was 3 years. More than half of mothers had two or more of the conditions assessed, and 10.7% had five or more.
Four conditions showed statistically significant differences in association with autism by maternal race and ethnicity: overweight or obesity, depression, asthma and pregnancy complications. Each had a stronger association among white mothers than among Black, Hispanic, or Asian and Pacific Islander mothers. Most of the maternal conditions examined, however, had similar relationships with autism across groups.
Autism prevalence in the study was 2.4% overall. It was 3.2% among Black children, 2.9% among Asian and Pacific Islander children, 2.5% among Hispanic children and 2.0% among white children. These are prevalence figures for this study cohort; they do not explain why the rates differed.
Why Group Differences Matter
The results challenge the assumption that a potential autism risk factor has the same relationship across all populations. Variation between groups can shape what researchers detect when they combine data, and it may help identify where more targeted research is needed.
The findings do not establish that the maternal conditions caused autism, or that the conditions themselves explain differences in autism prevalence. The authors said the stronger associations among white mothers could reflect differences in healthcare access, diagnostic practices, or unmeasured environmental and genetic factors. The study raises questions about how health and diagnoses are recorded, but it cannot determine which explanation accounts for the pattern.
For readers, the distinction matters: the research describes associations in a particular health system and time period. It does not show that an individual pregnancy or maternal diagnosis will result in autism.
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How Researchers Read the Records
Janecka and colleagues studied children receiving care through the Kaiser Permanente Northern California health system, born between 2010 and 2017. Both maternal conditions and children’s autism diagnoses were identified from health records. The study was retrospective, meaning researchers analyzed existing records rather than assigning exposures or following a trial.
In an accompanying editorial, Aisha Dickerson of Johns Hopkins Bloomberg School of Public Health noted that electronic records allow large studies but depend on people having access to care. A condition that is not diagnosed or recorded may not appear in the data. Differences in access or diagnosis could therefore affect comparisons between groups.
The study adds to earlier research linking conditions such as obesity, diabetes, hypertensive disorders of pregnancy, asthma and depression or anxiety with autism in offspring. Autism’s causes remain unresolved, and the study did not test a causal mechanism. Its authors also noted that factors beyond race and ethnicity, including insurance status, warrant investigation.
“As advantageous as electronic health records have proven to be for large-scale observational studies, these metrics still require healthcare access.”
— Aisha Dickerson, in an accompanying editorial
What the Study Cannot Explain
The findings show associations, not proof of cause and effect. They do not establish why four associations were stronger among white mothers or whether the pattern reflects differences in care, diagnosis, other exposures, or a combination of factors.
Researchers relied on health system records, so conditions that were not diagnosed or documented may have been missed. Follow-up was also limited: some children may receive an autism diagnosis at a later age than the study captured. The authors said other dimensions, including insurance status, may contribute to the observed differences. The study does not establish whether its results apply to populations outside this health system.
Questions for Future Research
The researchers said further work should examine additional factors that could alter the relationship between maternal health and autism, including insurance status and other dimensions of healthcare access. Longer follow-up could also capture diagnoses made after the study’s observation period.
The current report does not identify a single explanation for the group differences or set out a specific next study or timetable. For now, the results provide a basis for research into how maternal conditions, healthcare access and diagnosis interact across populations.
Key Questions
Did the study show that maternal health conditions cause autism?
No. It found associations between maternal conditions and autism diagnoses, but its retrospective design cannot establish that the conditions caused autism.
Which maternal conditions had different associations across groups?
Overweight or obesity, depression, asthma and pregnancy complications had stronger associations with autism among white mothers than among Black, Hispanic, or Asian and Pacific Islander mothers.
How many children were included?
The study followed 224,353 children born from 2010 to 2017 in the Kaiser Permanente Northern California health system. Of these, 5,448 were diagnosed with autism.
Why might the associations differ by race and ethnicity?
The study did not determine the reason. Its authors said possible explanations include healthcare access, diagnostic practices, and unmeasured environmental or genetic factors.
Source: rss
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