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Grand Rounds

Is Hyperemesis Gravidarum Associated with an Increased Risk for Autism?

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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)

METHODS:

  • 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

RESULTS:

  • 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

CONCLUSION:

  • 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”

Learn More – Primary Sources:

Autism Spectrum Disorders in Children Exposed in Utero to Hyperemesis Gravidarum

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Related ObG Topics:

Practical obstetrics info for your women's healthcare practice
Nausea and Vomiting in Pregnancy – Management Options for Hyperemesis Gravidarum
Does Maternal Hyperemesis Gravidarum Affect Health in Offspring?
MMR Vaccine and Autism: Another Major Study Demonstrating No Link
Does Folic Acid Supplementation in Pregnancy Reduce Risk for Autism Spectrum Disorder?

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