JMIR Publications

ABSTRACT

Background:

Maternal preeclampsia is associated with risk of autism spectrum disorders (ASD) in offspring. It is unknown whether risk is due to preeclampsia onset and/or clinical management of preeclampsia during pregnancy.

Objective:

The goal of this study is to examine whether number of days of fetal exposure to preeclampsia after diagnosis is associated with increased risk of ASD in offspring, considering gestational age of preeclampsia diagnosis.

Methods:

This retrospective cohort study included 364,588 mother-child pairs of singleton births between 2001-2014 in an integrated health care system. Demographic and medical history, maternal preeclampsia diagnosis, delivery, and child ASD diagnosis by age 5 were extracted from electronic medical records. Cox regression models were used to assess hazard ratios (HR) of offspring ASD associated with gestational age of preeclampsia onset and number of days from onset to delivery.

Results:

Preeclampsia occurred in 16,205 (4.4%) of pregnancies; 16.8% were diagnosed at <34 weeks gestation, 27.6% between 34-37 weeks, and 55.6% at ≥37 weeks. Median (IQR) days from preeclampsia diagnosis to delivery were 4 (2,16), 1 (1,3) and 1 (0,1) for <34, 34-37, and ≥37 weeks, respectively. Early preeclampsia diagnosis was associated with greater ASD risk (p= 0.003); HRs (95% CI) were 1.62 (1.33-1.98), 1.43 (1.20-1.69), and 1.23 (1.08-1.41) for diagnosis at <34, 34-37, and ≥37 weeks, relative to unexposed group. Within the preeclampsia group, number of days from diagnosis to delivery was not associated with ASD risk: HRs (95% CI) were 1.05 (0.70-1.57), 1.08 (0.77-1.51), 1.26 (0.93-1.71) for diagnosis at <34, 34-37, and ≥37 weeks, respectively.

Conclusions:

Early diagnosis of preeclampsia was associated with greater risk of ASD in offspring but number of days from diagnosis to delivery was not. Our study suggests clinical management for preeclampsia after diagnosis does not add additional ASD risk associated with preeclampsia.