Grand Rounds

Is Hyperemesis Gravidarum Associated with an Increased Risk for Autism?

BACKGROUND AND PURPOSE:

Getahun et al. (American Journal of Perinatology, 2019) analyzed whether HG is associated with increased risk of autism spectrum disorder (ASD), and whether this association can be modified by race, ethnicity, sex, exposure timing, and the medication used to treat hyperemesis gravidarum (HG)

Retrospective longitudinal cohort study
Participants
- Mother-child pairs (1991 to 2014)
- Singleton birth between 28w0d and 42w6d
Study design
- Children followed from 2 to 17 years
- Clinical records used to diagnosis HG and (specialist-confirmed) diagnosis of ASD

469,789 mother-child pairs were included
Children exposed to HG in-utero had higher rates of ASD
- Exposed to HG: 2.87/1,000 person-years
- Not exposed: 1.71/1,000 person-years
- adjusted hazard ratio (aHR) 1.53 (95% CI, 1.37 to 1.70)
Timing of exposure: First HG diagnosis in the first trimester exposure was associated with increased risk for ASD compared to unexposed children
- Hazard ratio: 1.58 (95% CI: 1.40–1.79)
HG was associated with ASD for both boys and girls
- Boys: aHR: 1.50 (95% CI: 1.33–1.70)
- Girls: aHR: 1.62 (95% CI: 1.28–2.05)
HG treatment medications were not associated with increased risk for ASD

HG may be associated with increased ASD risk
The authors suggest that knowing ASD risk may help identify children who may benefit from early intervention programs
Authors acknowledge limitations of the study design and that the data do not prove causation
However, “HG fulfills the Bradford–Hill criteria as a risk factor in terms of biological plausibility and timing”

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