Abstract
To investigate whether parental migration, parental region of origin, timing of child's birth in relation to maternal migration and parental reason for migration are associated with intellectual disability (ID) with and without autism. We used a register-based cohort of all individuals aged 0-17years in Stockholm County during 2001-2011. General estimating equation logistic model and additionally sibling comparison were used to calculate odds ratios (ORs) and 95% confidence intervals (CIs). The models were adjusted for child's sex and birth year and parental age at child's birth, and additionally for migrant-specific variables in the analyses including only children with migrant parent(s). Within the eligible sample of 670,098 individuals, 3781 (0.6%) had ID with autism, and 5076 (0.8%) had ID without autism. Compared with children with Swedish-born parents, children with both parents born abroad had an increased risk of ID with autism (OR=1.6, CI 1.5-1.8) and ID without autism (OR=1.9, CI 1.7-2.0). Among these children with both parents born abroad, it was protective of ID with autism when the child's birth occurred before and later than four years after maternal migration, which was replicated in the sibling comparison. The associations with both conditions were more pronounced with parental origin in regions comprising low- and middle-income countries and with reasons other than work or study. Parental migration is associated with ID regardless of co-occurrence of autism. Our results indicate an association between environmental factors during pregnancy related to migration and offspring ID with autism, although further confirmative studies are needed.
Highlights
Parental migration has been recognized as a potential factor associated with autism spectrum disorders since the 1980s.1,2 Recent studies considering co- occurrence of intellectual disability (ID) have shown that children with migrant parents have an increased risk of being diagnosed with autism with ID, but a decreased risk of autism without ID.3–5 This observation may hypothetically suggest that there is a relationship between parental migration and ID or cognitive impairment rather than the autism
Our results suggested that these associations are partly explained by environmental factors during pregnancy related to circumstances around migration for intellectual disability with autism, and by factors linked to parental origin in low-and middle-income countries for intellectual disability in general, further studies on these and other factors such as assessment bias and selection are needed
All individuals were categorized in four groups based on parental migration status using the Multi-generational Register and the Register of Total Population: children with both parents born in Sweden, both parents born abroad, mother born abroad and father born in Sweden and father born abroad and mother born in Sweden
Summary
Parental migration has been recognized as a potential factor associated with autism spectrum disorders ( autism) since the 1980s.1,2 Recent studies considering co- occurrence of intellectual disability (ID) have shown that children with migrant parents have an increased risk of being diagnosed with autism with ID, but a decreased risk of autism without ID.3–5 This observation may hypothetically suggest that there is a relationship between parental migration and ID or cognitive impairment rather than the autism. Examining children's exposure to maternal and paternal migration separately may give hints on whether environmental factors acting in utero or early in life are associated with the conditions. Studying the association might lead to finding a clue on whether exposure to any specific maternal migration phase (eg pre-m igration, travel and post-m igration phase) during different putative vulnerable periods in life, for example in utero, is associated with the conditions. It is not known whether parental reasons for migration are associated with ID with autism. The reasons for migration, such as a migration for work or study, versus being a refugee, or to join a family member entail different circumstances, Significant Outcomes
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