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A U.S. study of 224,353 children found that several maternal health conditions during pregnancy were associated with autism diagnoses, with most associations similar across racial and ethnic groups. Associations involving maternal overweight or obesity, depression, asthma and pregnancy complications were stronger among white mothers; the observational findings do not establish that these conditions cause autism.
A study of 224,353 children in a Northern California health system found that maternal health conditions during pregnancy were associated with autism diagnoses, with most associations broadly similar across racial and ethnic groups. Associations involving overweight or obesity, depression, asthma and pregnancy complications were stronger among white mothers than among Black, Hispanic, or Asian and Pacific Islander mothers, the researchers reported in JAMA Network Open. The study identifies differences in observed associations, not proof that maternal conditions cause autism.
Magdalena Janecka, PhD, of NYU Grossman School of Medicine, and colleagues analyzed health records for children born between 2010 and 2017. Of the children studied, 5,448 were diagnosed with autism; the mean age at diagnosis was 3 years. The researchers assessed 25 maternal diagnoses previously linked to autism in research.
Four conditions showed statistically significant differences in their association with autism by maternal race and ethnicity: overweight or obesity, depression, asthma and pregnancy complications. In each case, the association was stronger for children of white mothers than for children of Black, Hispanic, or Asian and Pacific Islander mothers. The study did not find that every maternal condition varied this way; two other factors, pain associated with female genital organs and the menstrual cycle, and bipolar disorder, were not significant after correction for multiple testing.
Across the study cohort, 2.4% of children had an autism diagnosis recorded. Reported prevalence 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 figures describe diagnoses in this health-system cohort, not necessarily prevalence in the wider population. Because the research was observational and relied on health records, it cannot establish that the maternal conditions caused autism or explain why the associations differed.
How Care Access Shapes the Findings
The findings matter because studies that combine data across populations may miss differences in how maternal health conditions are diagnosed, treated or recorded. Janecka told MedPage Today that research often assumes potential autism risk factors have the same effects across groups. Her team instead examined whether some associations varied, while noting that race and ethnicity represent only part of the picture.
The results may also point to differences in healthcare access and diagnosis rather than differences in underlying biology. A condition that is less often identified or documented in one group could appear to have a weaker association in records, even if the actual health burden differs less. The study cannot determine which explanation accounts for its results. Better understanding those differences could help researchers design studies and care systems that represent families more accurately, without treating an association as an individual prediction of a child’s outcome.
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What the Study Measured
Earlier research has reported associations between autism diagnoses and several maternal conditions, including obesity, diabetes, hypertensive disorders of pregnancy, asthma and psychiatric conditions such as depression and anxiety. This study adds a comparison of those associations across maternal racial and ethnic groups, using records from one large U.S. health system.
The study was conducted in Kaiser Permanente Northern California and included a defined group of children with available health-system records. Mothers had a median of two assessed conditions; 53.4% had two or more and 10.7% had five or more. The researchers noted that diagnoses made after the study’s follow-up period would not be captured. The results therefore reflect recorded diagnoses in this cohort and time frame, not all children or all maternal health experiences.
“As advantageous as electronic health records have proven to be for large-scale observational studies, these metrics still require healthcare access.”
— Aisha Dickerson, PhD, MSPH, of Johns Hopkins Bloomberg School of Public Health, in an accompanying editorial
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Limits of Records and Follow-Up
The study shows associations, not causation. It does not establish that any maternal condition caused autism, nor does it explain why the four associations were stronger among white mothers. Researchers said differences in healthcare access, diagnostic practices, or unmeasured environmental and genetic factors could contribute. Other influences, including insurance status, also need study.
Both maternal conditions and autism diagnoses were identified through health-system records. As Dickerson noted in her editorial, this approach depends on access to care and on diagnoses being recorded. The study also had a finite follow-up period, so autism diagnoses made at older ages may not have been included. Its results come from one health system and may not apply in the same way to other populations.
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Questions for Follow-Up Research
The researchers said additional work should examine factors beyond race and ethnicity, including insurance status, and investigate the reasons behind differences in recorded associations. Studies that include longer follow-up and assess variation in healthcare access, diagnosis and treatment could help clarify whether the observed patterns reflect differences in health conditions, in their detection, or in other influences.
For now, the findings add detail to research on maternal health and autism but do not establish a cause or offer a way to predict an individual child’s diagnosis. The next step is to test whether the associations hold in other populations and to determine how health-system and social factors shape the patterns.
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Key Questions
Did the study show that maternal health conditions cause autism?
No. It was an observational study based on health records. It found associations but cannot show that the conditions caused autism.
Which maternal conditions had associations that varied by race and ethnicity?
The associations for overweight or obesity, depression, asthma and pregnancy complications were stronger among white mothers than among Black, Hispanic, or Asian and Pacific Islander mothers in this study.
How many children were included?
The study included 224,353 children born from 2010 to 2017 in the Kaiser Permanente Northern California health system. A total of 5,448 had an autism diagnosis recorded.
Why might health records affect the results?
Records reflect conditions that were diagnosed and documented. People with different access to healthcare may have different chances of receiving or recording a diagnosis, so the data may not capture all health conditions equally.
What are the main limits of the findings?
The study cannot establish causation, relied on one health system’s records and had a limited follow-up period. It may have missed diagnoses made at later ages, and other factors could help explain the observed differences.
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