ROCKVILLE, Md.—Gestational weight gain may be associated with autism-related behaviors among children who have a greater pre-disposition to these behaviors and who have mothers with pre-pregnancy overweight or obesity, according to a new study in Obesity, The Obesity Society's (TOS) flagship journal.
Excessive gestational weight gain has been associated with neurodevelopmental outcomes in children, including autism spectrum disorder and related traits. However, it is unclear how pre-pregnancy body mass index (BMI) or familial susceptibility to autism spectrum disorder influences the gestational weight gain-autism traits association, according to experts.
"Our study findings are relevant for clinicians, pregnant individuals and those considering becoming pregnant as gestational weight gain and pre-pregnancy body mass index are modifiable factors, that when addressed, can promote health for the pregnant person and their developing fetus," said Marisa A. Patti, A.J. Drexel Autism Institute, Drexel University, Philadelphia, Pa. Patti is the corresponding author of the study.
Patti added that for clinicians, it is key to identify sub-populations that may be more susceptible to neurodevelopmental outcomes (in this case, autism-related behaviors in children) to promote more targeted interventions among pregnant people. Pregnant individuals may benefit from counseling or education on guidelines for healthy weight gain during pregnancy such as those outlined by the American College of Obstetricians and Gynecologists. While pre-pregnancy BMI is not modifiable during pregnancy, gestational weight gain can be. Those considering becoming pregnant can best prepare themselves to optimize their health during gestation by modifying their BMI prior to becoming pregnant, and by knowing recommended weight gain trajectories.
Using data from the Early Autism Risk Longitudinal Investigation (EARLI) study, a familial enriched co-hort of mothers who had a previous child with autism and the Health Outcomes and Measures of the Environment (HOME) study, a general population co-hort, gestational age and pre-pregnancy BMI category-specific gestational weight gain z scores were calculated. Caregivers completed the Social Responsiveness Scale to assess the presence and severity of autism-related traits in children 3-to-8 years old. The association between gestational weight gain z scores and autism-related behaviors in children were estimated using quantile regression.
In the HOME study, among mothers who had overweight or obesity pre-pregnancy BMI values, gestational weight gain z scores and social responsiveness scale scores were positively associated in children with more autism spectrum disorder related traits, but not in children with fewer autism-related traits. For example, the strength and magnitude of associations between gestational weight gain z scores and social responsiveness scale T-scores among those who had overweight or obesity pre-pregnancy BMI values increased from the 50th to the 95th percentiles of the social responsiveness scale T-score distribution. Similar patterns were observed in the EARLI study among mothers with pre-pregnancy obesity.
Other authors of the study include Joseph M. Braun, Department of Epidemiology, Brown University, Providence, R.I.; Lisa A. Croen, Division of Research, Kaiser Permanente Northern California, Oakland, Calif.; Aimin Chen, Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia; M. Daniele Fallin, Department of Mental Health, Johns Hopkins University, Baltimore, Md.; Jane Khoury, Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Ohio. Khoury and Kimberly Yolton are also with the Department of Pediatrics and Department of Environmental and Public Health Sciences, University of Cincinnati College of Medicine, Ohio. Yolton is also with the Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Ohio. Kristen Lyall and Craig Newschaffer, A.J. Drexel Autism Institute, Drexel University, Philadelphia, Pa. also co-authored the study. Newschaffer is also with the College of Health and Human Development, Pennsylvania State University. Co-authors also include Irva Hertz-Picciotto and Rebecca J. Schmidt, Department of Public Health Sciences, University of California, Davis.
Braun was financially compensated for serving as an expert witness for plaintiffs in litigation related to per- and polyfluorinated substance-contaminated drinking water. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results. The other authors declared no conflicts of interest.
This research was funded by the National Institutes of Health, R01 ES026903, R01 ES016443, R01 ES024381, R01 ES020349, P01 ES011261, R01 ES014575 and R01 ES020349.
The study, titled "Pre-pregnancy BMI, Gestational Weight Gain and Susceptibility to Autism-related Traits: The EARLI and HOME Studies," will be published in the print issue of Obesity in May 2023.
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