Obesity and Diabetes During Pregnancy Linked to Higher Risk of Autism-Related Traits in Children

Authors: Kristen Lyall, Christine Ladd-Acosta, et al.

Who sponsored this study?

This research was supported by the Environmental influences on Child Health Outcomes (ECHO) program, Office of The Director, National Institutes of Health.

What were the study results?

Maternal obesity and gestational diabetes were associated with indicators of autism-related social behaviors. Investigators did not see increases in these behaviors for children of mothers with preeclampsia or gestational hypertension. Neither preterm birth or low birth weight, which are common complications of obesity and gestational diabetes, did not seem to drive the associations with these pregnancy conditions.

What was the study's impact?

Obesity and gestational diabetes are common pregnancy conditions, so understanding their impact on the developing child is an important public health issue. This study suggests that these conditions may increase the likelihood of ASD-related traits, highlighting the need for better prenatal care and more monitoring of pregnant women experiencing conditions like obesity.

Why was this study needed?

Many studies have linked childhood autism diagnosis back to maternal health conditions during pregnancy—like obesity, gestational diabetes (high blood sugar during pregnancy), gestational hypertension (high blood pressure during pregnancy), and preeclampsia (high blood pressure during pregnancy and signs of kidney/liver damage). But less is known about how these conditions may relate to subtler changes in child social development. This research looks at how risk factors of obesity, gestational diabetes, gestational hypertension, and preeclampsia relate to autism-related traits like social communication more broadly.

Who was involved?

This study included nearly 7,000 participants from 40 ECHO cohorts across the United States. Eight of these cohorts included participants considered to be at higher risk for autism spectrum disorder (ASD) based on known risk factors. The study only included cohorts that collected information on at least one of the four pregnancy conditions listed above and child social development/autism-related behaviors. Children were between the ages of 2.5-18 years, with an average age of approximately 8 years old.

What happened during the study?

The research team pulled together information on maternal health conditions during pregnancy, maternal age, child social development/autism-related behaviors, and participant demographics. They then examined the relationship between each pregnancy condition, separately and in combination, and child social development outcomes.

What happens next?

More work is needed to determine the underlying biologic and social mechanisms linking maternal obesity to child social behaviors and autism.

Where can I learn more?

Access the full journal article, titled “Cardiometabolic pregnancy complications in association with autism-related traits as measured by the Social Responsiveness Scale in ECHO” in the American Journal of Epidemiology.

The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Published March 31, 2022

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Obesity and Diabetes During Pregnancy Linked to Higher Risk of Autism-Related Traits in Children

ECHO Study Suggests Link Between Smoking During Pregnancy and Autism-Related Traits in Children

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ECHO Study Suggests Link Between Smoking During Pregnancy and Autism-Related Traits in Children

Authors: Rashelle J. Musci, Irva Hertz-Picciotto, et al.

Who sponsored this study?

This research was supported by the Environmental influences on Child Health Outcomes (ECHO) program, Office of The Director, National Institutes of Health.

What were the study results?

Smoking before or during pregnancy was consistently associated with ASD traits, such as symptoms of social impairments. Additionally, babies born at full term had a somewhat higher risk of receiving an ASD diagnosis as a child if their mothers smoked before or during the pregnancy.

More counseling is needed for pregnant women or those planning a pregnancy to help them understand how these potential risks for the child’s behavioral development add to other poor outcomes associated with smoking during pregnancy, such as low birthweight, increased likelihood of fetal or infant death, asthma in early childhood, or attention deficit hyperactivity disorder (ADHD).

Footnote: Results reported here represent results from 11 or seven studies, depending on the outcome. Other or future studies may provide new information or different results. Consult your healthcare professional for guidance on how to limit your unborn child’s exposure to tobacco smoke. However, please also note that you have a greater chance of improving your child’s health and their social and behavioral development the sooner you quit or reduce smoking.

What was the study's impact?

There are many reasons for women to limit their exposure to tobacco smoke during pregnancy—tobacco smoke increases risk for low birthweight, ectopic pregnancy, a premature delivery, or fetal/infant death. Less research has been done to learn how tobacco smoke can influence children’s health, although studies have linked prenatal smoking to higher childhood asthma and ADHD risk. This study shows how prenatal exposure to cigarette smoke may also harm a child’s social development. Social skills can be important for success in school and getting along with others. Doctors, child educators, and other health and daycare providers should also know that children exposed to prenatal cigarette smoke may also be at higher risk for developing ASD.

Why was this study needed?

Previous studies provide varying results on how tobacco smoke exposure during pregnancy may affect risk for autism spectrum disorder (ASD) in children. Exposures to air pollution, which has many of the same chemicals as tobacco smoke but at lower levels, have also been linked with ASD. ASD is a complex condition that involves not only trouble in social interactions but also communication problems and patterns of repetitive behaviors or narrow interests.

The research team set out to conduct a study with participants from across the U.S. that could clear up inconsistencies found in previous research. Additionally, no other research has looked at the relationship between maternal tobacco smoking and milder autism-like symptoms of social impairment.

Who was involved?

Researchers studied approximately 11,000 children in 13 cohorts around the U.S. who either had a diagnosis of ASD, social impairment measurable on the Social Responsive Scale, or both. There also had to be information on exposure to prenatal smoking and other factors that could influence the study results.

What happened during the study?

Researchers pulled together and analyzed results from each cohort related to maternal smoking behaviors before or during pregnancy and childhood ASD diagnosis or ASD-related social impairment. The team took specific actions to prevent other factors related to the children and mothers from affecting the quality and consistency of the data.

What happens next?

Future studies can help researchers identify when babies are most at-risk to cigarette smoke exposure and how other factors associated with prenatal smoking may contribute to negative health outcomes.

Where can I learn more?

Access the full journal article, titled “Maternal Tobacco Smoking and Offspring Autism Spectrum Disorder or Traits in ECHO Cohorts” in Autism Research.

The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Published February 24, 2022

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ECHO Study Suggests Link Between Smoking During Pregnancy and Autism-Related Traits in Children

ECHO Study Suggests Link Between Maternal Stress During Late Pregnancy and Infant Pacifier Sucking Patterns

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ECHO Study Suggests Link Between Maternal Stress During Late Pregnancy and Infant Pacifier Sucking Patterns

Author(s): Emily Zimmerman, Andréa Aguiar, et al.

Who sponsored this study?

This research was supported by the Environmental influences on Child Health Outcomes (ECHO) program, the Office of the Director, and the National Institutes of Health.

Footnote: The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

What were the study results?

The researchers found that higher maternal stress during late pregnancy was associated with fewer but longer sucking bursts when the infants sucked on the special pacifier. It is important to note that the maternal stress levels and infants’ sucking behaviors between the two cohorts were different. This could be due to differences between the two cohorts’ cultures, geographical locations, ethnicities, incomes, and education levels.

Footnote: Results reported here are for a single study. Other or future studies may provide new information or different results. You should not make changes to your health without first consulting your healthcare professional.

What was the study's impact?

This is the first study investigating the link between maternal stress and infants’ sucking patterns. The results of this study may help promote awareness and earlier detection of stress exposure during pregnancy and, as a result, improve the treatment of stress-exposed infants. This study also researched these outcomes in two groups of participants with different demographics and stress levels, which may allow for earlier detection of high maternal stress exposure in lower SES populations.

Why was this study needed?

Previous studies show that a mother’s stress during pregnancy can affect her baby’s development. But less is known about how a mother’s stress during pregnancy relates to their infant’s brain function early in life. Infants’ sucking patterns have been used to measure brain function soon after birth. This study investigated whether there was any relationship between mothers’ stress in pregnancy and their young infants’ sucking patterns.

Who was involved?

The study included participants from two ECHO cohorts—one from Urbana-Champaign, Illinois and the other from Manati, Puerto Rico.

What happened during the study?

The researchers surveyed mothers regarding their stress during late pregnancy using the Perceived Stress Scale, which has 10 questions. Next, between one and eight weeks after the mothers gave birth, the researchers measured the infants’ sucking behaviors by having them suck on a pacifier connected to a pressure detector for approximately five minutes.

What happens next?

Future studies will look at the question of how early sucking behaviors relate to a child’s growth and development, in particular their brain function and cognitive development.

Where can I learn more?

Access the full journal article, titled “Examining the Association Between Prenatal Maternal Stress and Infant Non-Nutritive Suck” in Pediatric Research.

The content is the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Published December 16, 2021

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ECHO Study Suggests Link Between Maternal Stress During Late Pregnancy and Infant Pacifier Sucking Patterns

ECHO Review Finds Air Pollution May Be Associated with Child Brain Development, Behavior

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ECHO Review Finds Air Pollution May Be Associated with Child Brain Development, Behavior

Author(s): Heather E. Volk, Frederica Perera, Joseph M. Braun, Samantha L. Kingsley, Kim Gray, Jessie Buckley, Jane E. Clougherty, Lisa A. Croen, Brenda Eskenazi, Megan Herting, Allan C. Just, Itai Kloog, Amy Margolis, Leslie A. McClure, Rachel Miller, Sarah Levine, Rosalind Wright

Who sponsored this study?

This research was supported by the Environmental influences on Child Health Outcomes (ECHO) Program, Office of The Director, National Institutes of Health.

What were the study results?

ECHO provides a unique opportunity to study how air pollution can affect children’s brain development and behavior in a large, diverse study population. It also has the ability to study pollutant exposures by geographic area, which has been a limitation in previous research.

What was the study's impact?

This study sets up the possibility of future work in ECHO on the effect of prenatal air pollution exposure on brain development in children.

Why was this study needed?

This study summarized information on different ways to measure prenatal air pollution exposure and what we know about how air pollution affects children’s behavior and brain development. It also helps create a plan for ECHO to study how being exposed to air pollution in the womb may affect children’s behavior.

Who was involved?

This paper uses summary data from ECHO to learn if there may be enough participants in the future to study how air pollution can affect children’s brain development and behavior.

What happened during the study?

Researchers reviewed earlier papers on air pollution and child development to summarize what those studies found. Then, they used that information to develop a plan that ECHO might use to fill gaps in that earlier work to advance children’s health.

What happens next?

Future studies will do the work described here – to examine air pollution exposure in ECHO participants by geographic area to determine how air pollution can affect the brain.

Where can I learn more?

Access the full journal article , titled “Prenatal air pollution exposure and neurodevelopment: A review and blueprint for a harmonized approach within ECHO.”

The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Published: May 2021

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ECHO Review Finds Air Pollution May Be Associated with Child Brain Development, Behavior

ECHO Researchers Test a Short Questionnaire for Measuring Autism-Related Behaviors in Children

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ECHO Researchers Test a Short Questionnaire for Measuring Autism-Related Behaviors in Children

Author(s): Kristen Lyall and Craig Newschaffer

Who sponsored this study?

This research was supported by the Environmental influences on Child Health Outcomes (ECHO) program, Office of The Director, National Institutes of Health.

What were the study results?

The researchers found that the short questionnaire did a good job predicting autism diagnosis and measuring social communication behaviors. However, more research is needed to see how the short questionnaire compares in other ways to the long questionnaire.

Footnote: Results reported here are for a single study. Other or future studies may provide new information or different results. You should not make changes to your health without first consulting your healthcare professional.

What was the study's impact?

This study suggests that the shorter version of the questionnaire is quicker, easier for participants to complete, and produces the same quality of work as the longer version. This work is also important because it may be helpful for people who do not meet the definition of ASD, but still face challenges in social communication and could benefit from help.

Why was this study needed?

Autism spectrum disorder (ASD) is a condition defined by challenges in social communication. Social communication refers to how we use language or words in social interactions with others, including how we may change words we use in different situations and with different people. This study wanted to see if a shorter version of a social communication questionnaire could predict ASD and other challenges related to social communication as correctly as a longer version. Having a shorter survey would mean that it would take participants less time to complete it. This study could also help identify questionnaires that could be used to find different social communication challenges in people with and without ASD.

Who was involved?

More than 3,000 people completed questionnaires for this study, including almost 200 parents who had a child with ASD between the age of 2-18. Participants were from research studies from across the United States.

What happened during the study?

Researchers used questionnaires from 10 different research projects in the United States to compare how well information from the shorter version predicted ASD diagnosis and measured broader behaviors in people without ASD diagnosis.

What happens next?

We now know that the shorter version of the questionnaire is comparable to the longer version, in terms of measuring these behaviors and predicting ASD diagnosis. However, more work is needed to confirm that the short questionnaire performs in all the same ways that the longer one does, since the study addressed only a few of these questions.

Note: This study is part of a project examining how different versions of this questionnaire measure ASD and broader, related social communication traits.

Where can I learn more?

More information on the questionnaire used in this study can be found through the publisher website and additional information on the shortened questionnaire can be found on PubMed .

Access the full journal article , titled “Distributional Properties and Criterion Validity of a Shortened Version of the Social Responsiveness Scale: Results from the ECHO Program and Implications for Social Communication Research.”

The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Published: September 17, 2020

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ECHO Researchers Test a Short Questionnaire for Measuring Autism-Related Behaviors in Children