Pregnant Mothers' Medical Claims and Associated Risk of Their Children being Diagnosed with Autism Spectrum Disorder.

Genevieve Grivas,Richard Frye,Juergen Hahn

doi:10.3390/jpm11100950

Abstract

A retrospective analysis of administrative claims containing a diverse mixture of ages, ethnicities, and geographical regions across the United States was conducted in order to identify medical events that occur during pregnancy and are associated with autism spectrum disorder (ASD). The dataset used in this study is comprised of 123,824 pregnancies of which 1265 resulted in the child being diagnosed with ASD during the first five years of life. Logistic regression analysis revealed significant relationships between several maternal medical claims, made during her pregnancy and segmented by trimester, and the child’s diagnosis of ASD. Having a biological sibling with ASD, maternal use of antidepressant medication and psychiatry services as well as non-pregnancy related claims such hospital visits, surgical procedures, and radiology exposure were related to an increased risk of ASD regardless of trimester. Urinary tract infections during the first trimester and preterm delivery during the second trimester were also related to an increased risk of ASD. Preventative and obstetrical care were associated with a decreased risk for ASD. A better understanding of the medical factors that increase the risk of having a child with ASD can lead to strategies to decrease risk or identify those children who require increased surveillance for the development of ASD to promote early diagnosis and intervention.

Highlights

Autism spectrum disorder (ASD) is an early onset neurodevelopmental disorder characterized by difficulties in social communication/interactions and by the presence of restricted and repetitive behaviors [1]
This trend agrees with that reported in a CDC surveillance completed within the same time period as this study [43] except for those of Asian race, which was found to vary widely depending on location and where our study shows a significantly larger proportion in the autism spectrum disorder (ASD) women’s cohort (p-value < 0.001, Table 3)
Clinical Pathology during the first trimester, and Services Office or Other Outpatient during the second trimester. These findings suggest that claims not relating to the pregnancy nor delivery are associated with an increased risk of ASD regardless of trimester

Summary

Introduction

Autism spectrum disorder (ASD) is an early onset neurodevelopmental disorder characterized by difficulties in social communication/interactions and by the presence of restricted and repetitive behaviors [1]. It is generally acknowledged that investigation of environmental risk factors for ASD should be limited to the life of the child, and include the prenatal and preconception period [5]. Maternal endocrine or hormonal disorders, such as polycystic ovary syndrome, show an increased risk of offspring developing ASD [11]. The presence of maternal infection during pregnancy significantly increases the risk of ASD in the offspring [19], with studies suggest this effect is specific for bacterial [20], viral [21], severe [22,23] or febrile [24,25] infections

Methods

Findings

Discussion

Conclusion