Maternal autistic traits during pregnancy tied to elevated risk of preterm birth: JAMA

The cohort study of 87 687 women showed an association of higher levels of maternal autistic traits with increased risk of preterm birth, particularly very preterm birth and small for gestational age. These risks were most noticeable for women within the clinical range, although most of them lacked a formal diagnosis of autism spectrum disorder (ASD).

"Acknowledging the risks and providing timely and tailored antenatal care support to women having high levels of autistic traits in the general population, specifically women with autistic traits within the clinical range, irrespective of formal diagnosis, is warranted," the researchers suggested.

Previous studies have shown that women with high autistic trait levels in the general population may experience larger health disparities during pregnancy, specifically, women diagnosed with ASD, which in turn may be tied to an increased risk of adverse birth outcomes. Mariko Hosozawa, National Center for Global Health and Medicine, Tokyo, Japan, and colleagues aimed to determine the association between maternal autistic traits and the general population's risk of adverse birth outcomes.

The researchers included women from the Japan Environmental Children’s Study, a nationwide, multicenter prospective birth cohort. Expecting mothers were recruited between 2011 and 2014.

Using the short form of the Autism-Spectrum Quotient Japanese version (AQ-J10) (score range, 0-10; clinical range, ≥7), autistic traits were self-reported during the second and third trimesters.

Data on neonates born small for gestational age (SGA) and preterm birth (<37 weeks’ gestation) were transcribed from medical records. The research group also analysed gestational age groups (very preterm birth, <32 weeks’ gestation; moderate-to-late preterm birth, 32-36 weeks’ gestation).

The study led to the following findings:

• 87 687 women (mean age, 31.2 years) were included in the study, of which 2.7% had AQ-J10 scores within the clinical range, yet only 0.02% were diagnosed with autism spectrum disorder.
• A higher AQ-J10 score was associated with an increased risk of all birth outcomes, including preterm births (relative risk [RR] per 1-SD increase, 1.06), moderate-to-late preterm births (RR per 1-SD increase, 1.05), very preterm births (RR per 1-SD increase, 1.16), and child born SGA (RR per 1-SD increase, 1.04) after adjusting for maternal and pregnancy-related factors.
• The risks of all outcomes increased with higher AQ-J10 scores; compared with women below the clinical range, women within the clinical range had a greater risk of preterm births (RR, 1.16), very preterm births (RR, 1.49), moderate-to-late preterm births (RR, 1.12), and a child born SGA (RR, 1.11).

The researchers suggest that "healthcare practitioners should acknowledge the significant perinatal health disparity experienced by women with a high level of autistic traits, particularly those with autistic traits in the clinical range."

They further suggest providing inclusive comprehensive antenatal care, including the assessment of antenatal psychological distress and offering timely and tailored support that meets the needs of women, irrespective of whether a formal diagnosis of ASD is received.

"If provided, these approaches may improve maternal well-being with the potential to reduce adverse birth outcomes risk and have a downstream effect on child development and health," they concluded.

Reference:

Hosozawa M, Cable N, Ikehara S, et al. Maternal Autistic Traits and Adverse Birth Outcomes. JAMA Netw Open. 2024;7(1):e2352809. doi:10.1001/jamanetworkopen.2023.52809