Maternal Health During Pregnancy Linked to Autism Across Racial and Ethnic Groups: Study
USA: Researchers have found in a large U.S. retrospective study that maternal health conditions during pregnancy were consistently associated with autism spectrum disorder (ASD) across racial and ethnic groups. Overweight, obesity, depression, asthma, and pregnancy complications showed stronger associations among White mothers. The differences may reflect disparities in healthcare access, diagnostic practices, or unmeasured environmental and genetic factors.
The study, published in JAMA Network Open, examined whether the relationship between maternal health conditions during pregnancy and autism in children differed according to maternal race and ethnicity. The research was led by Khaoula Ben Messaoud, PhD, Department of Child and Adolescent Psychiatry, New York University Grossman School of Medicine, and colleagues.
Autism affects approximately 1 in 31 children in the United States, with documented differences across racial and ethnic groups in prevalence, age at diagnosis, and access to autism-related services. Although several maternal health conditions have previously been associated with autism in offspring, less was known about whether these relationships vary across racial and ethnic populations.
The retrospective cohort included 224,353 children born at Kaiser Permanente Northern California between 2010 and 2017, who were followed until February 29, 2020, autism diagnosis, disenrollment, or death. Researchers evaluated 25 maternal health conditions previously associated with autism during the perinatal period.
Cox proportional hazards models assessed the associations between maternal conditions and autism, including potential differences by maternal race and ethnicity. Analyses adjusted for maternal age, insurance type, child sex, birth year, and maternal healthcare utilization.
Findings
- Among 224,353 children, 5,448 (2.4%) were diagnosed with autism during follow-up.
- Autism prevalence was highest among children of Black mothers (3.2%), followed by Asian and Pacific Islander mothers (2.9%), Hispanic mothers (2.5%), mothers of other or unknown race and ethnicity (2.4%), and White mothers (2.0%).
- Most of the 25 maternal health conditions demonstrated broadly similar associations with autism across racial and ethnic groups.
- Significant differences in the strength of associations were observed for four conditions: overweight and obesity, depressive episodes, asthma, and other maternal diseases complicating pregnancy.
- These four conditions showed stronger associations with autism among children of White mothers than among children of Black, Hispanic, or Asian and Pacific Islander mothers.
The researchers noted that differences in association strength may reflect disparities in maternal healthcare access, diagnostic practices, treatment patterns, or unmeasured environmental and genetic factors rather than fundamentally different effects of maternal conditions across racial and ethnic groups.
The study had several limitations, including limited follow-up that may have missed autism diagnoses at older ages and reduced statistical power in some racial and ethnic subgroups. Nonsignificant interactions should not be interpreted as evidence of no heterogeneity, while factors such as socioeconomic status, migration history, family history, and childhood clinical characteristics were not fully captured.
Overall, maternal health conditions during pregnancy showed broadly consistent associations with autism across racial and ethnic groups, although some associations varied in strength. Further research in larger, diverse populations is needed to clarify these differences and inform strategies to reduce maternal and child health disparities.
Reference:
Ben Messaoud K, Khachadourian V, Anderson M, Janecka M, Croen LA. Racial and Ethnic Differences in Maternal Health and Autism. JAMA Netw Open. 2026;9(10):e2637501. doi:10.1001/jamanetworkopen.2026.37501
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