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The Association Between Prenatal Exposure to Maternal Infection and Autism Spectrum Disorder in the Boston Birth Cohort
Objectives: We aim to estimate the association between prenatal exposure to maternal infections, including influenza and genitourinary infections, and ASD in a prospective birth cohort of an understudied urban minority population in the United States.
Methods: We used data from the Boston Birth Cohort (BBC), a prospective birth cohort with pregnancy exposure, early life factors, and phenotypic data available for over 8,000 mother-child dyads recruited at the Boston Medical Center. The BBC enrolls predominantly urban, low-income minority mothers and their children (approximately 38% self-identify as black/African American, 22% Hispanic, 19% Haitian, 8.5% white). We performed a nested case-control analysis including 109 children with ASD and 833 children with typical development. ASD information was obtained from electronic medical record data, based on the presence of relevant ICD-9-CM hospital diagnosis codes from pediatric outpatient, inpatient, and emergency room visits. Information on maternal history of infection during a child's gestation was obtained from postpartum maternal questionnaires, given 24-72 hours after delivery, years prior to any ASD diagnosis. Analyses were adjusted for socioeconomic status as represented by educational attainment, marital status, and race. Sensitivity analyses further included adjustment for child sex, maternal age, birth year, parity, and maternal smoking during pregnancy.
Results: No association was found between self-reported maternal history of influenza, fever, or genitourinary (GU) infections and risk of ASD development in the offspring in either unadjusted (flu, OR of 1.03 [95% CI 0.60-1.68]; fever, 1.38 [0.71-2.52]; GU infection, 0.63 [0.39-1.00]) or adjusted analyses (flu, 1.05 [0.62-1.73]; fever, 1.39 [0.71 - 2.54]; GU infection, 0.67 [0.41-1.06]). Further adjustment for child sex, maternal age, birth year, parity, and maternal smoking during pregnancy did not alter these null associations.
Conclusions: In contrast to the results from several large studies of European registries or predominantly white American populations, the Boston Birth Cohort, a large urban, minority prospective birth cohort does not provide evidence for an association between history of exposure to infection during gestation and later development of Autism Spectrum Disorder.