Table 1.
Characteristics of the included studies (n = 12) regarding the association between maternal diabetes and autism spectrum disorders in the offspring
Author, year | Country | Ethnic origin |
Sample sized | Maternal diabetes criteria |
Autism criteria | Age of autism children |
Crude risk estimates (95 % CI) |
Adjusted risk estimates (95 % CI) |
Matched or adjusted covariates |
---|---|---|---|---|---|---|---|---|---|
Case–control studies | |||||||||
Piven et al. (1993) | USA | N/A | 39/39 | N/A | ADI and ADOS (autism) |
Mean 14.5 year | N/A | 3.08 (0.12–77.91) |
Birth ordera |
Juul-Dam et al. (2001) | USA | Mixed | 74/? | N/A | DSM-IV, ADI-R, CARS, and ADOS (autism and PDD- NOS) |
Range 2.5–4 year |
3.28 (1.32–8.17) | N/A | Noneb |
Hultman et al. (2002) | Sweden | Caucasians | 408/ 2,040 |
ICD-8 and ICD- 9 (pregestational and gestational diabetes) |
ICD-9 (autism) | Mean 4.4 (boy)/ 4.6 (girl) |
1.80 (0.60–5.70) | 1.20 (0.30–5.70) | Sex, year, hospital of birth, maternal smoking, pregnancy- induced hypertensive diseases, and other maternal factors (maternal age and parity, and mother’s country of birth) |
Croen et al. (2005) | USA | Mixed | 407/ 2,095 |
ICD-9-CM (type 1 diabetes during pregnancy) |
ICD-9-CM (ASD) | Range 3–7 year | 2.90(1.00–8.80) | 2.60 (0.80–7.90) | Sex, birth year, hospital of birth, maternal age, maternal education, maternal race/ ethnicity, and plurality |
Leonard et al. (2006) | Australia | N/A | 191/ 236,964 |
ICD-9 (pregestational and gestational diabetes) |
DSM-IV-R (ASD with intellectual disability) |
Range 0–16 year |
2.89(1.28–6.51) | 2.95 (1.30–6.73) | Infant sex, birth order, maternal ethnicity, age group, marital status, height, country of birth, health insurance status, and paternal occupation, and the accessibility/remoteness index of Australia |
Brimacombe et al. (2007) | USA | Mixed | 164/ 115,542 |
N/A | DSM-IV, CARS, and ADOS (ASD) |
Mean 6.8 year | 1.61 (0.82–3.17) | N/A | Nonec |
Buchmayer et al. (2009) | Sweden | Caucasians | 1,216/ 6,080 |
ICD-9 and ICD- 10 (pregestational and gestational diabetes) |
ICD-9 and ICD-10 (autistic disorder) |
<10 year | 1.13 (0.67–1.89) | 0.90 (0.49–1.67) | Age, gender, birth year, birth hospital, maternal age, smoking, maternal country of birth, whether the mother lived with the father, and maternal schizophrenia |
Elhameed et al. (2011) | Egypt | N/A | 14/28 | N/A | CARS (autism) | Mean 10.9 year | 6.33 (0.24–165.88) |
N/A | Nonea |
Krakowiak et al. (2012) | USA | Mixed | 517/315 | N/A | ADI-R and ADOS (ASD) |
Mean 3.65 year | 1.51 (0.86–2.74) | 1.52 (0.82–2.83) | Age, gender, and regional center catchment area, mother’s age at delivery, race/ethnicity, education level, delivery payer, calendar time, child’s age at enrollment and gender, and catchment area |
Cohort studies | |||||||||
Burstyn et al. (2010) | Canada | Mixed | 1,138/ 218,890 |
ICD-9 (pregestational and gestational diabetes) |
ICD-9 (ASD) | 1,998 birth cohort: 69 mo (boy)/74 mo (girl); 2,002 birth cohort: 45 mo(boy )/40 mo (girl) |
1.87(1.14–3.06) for pregestational diabetes; 1.41 (1.07–1.85) for gestational diabetes |
1.65 (1.01–2.71) for pregestational diabetes; 1.24 (0.94–1.65) for gestational diabetes |
Maternal age, maternal weight, maternal height, bleeding, cigarette smoking, poor weight gain, parity, socioeconomic status of mother, presentation, type of labour, delivery by Caesarian section, gestational age, birth weight, Apgar at 1 min and 5 min, female child, and birth year |
Dodds et al. (2011) | Canada | N/A | 924/ 129,733 |
ICD-9 and ICD- 10 (pregestational and gestational diabetes) |
ICD-9 (autism, other specified PDD), and ICD-10 (autism, atypical autism, Asperger syndrome, and unspecified PDD) |
Range 0–17 year |
1.98 (0.94–4.16) for pregestational diabetes; 1.29 (0.90–1.83) for gestational diabetes |
N/A | None |
Lyall et al. (2012) | USA | Mixed | 793/ 66,445 |
N/A | ADI-R (ASD) | N/A | 2.34 (1.80–3.04) | 1.76 (1.34–2.32) | Race, marital status, income, and spouse education, age, age-at- first-birth, and parity, twin births, pregnancy-related high blood pressure, toxemia, induced abortions, and miscarriages |
ADI-R autism diagnostic interview-revised, ADOS autism diagnostic observation schedule, CARS childhood autism rating scale, DSM-IV-R diagnostic and statistical manual of mental disorders, fourth edition, recommendations, ICD international classification of diseases, PDD pervasive developmental disorders
Controls were siblings of the cases
Control group was the entire US population
Control group was the New Jersey population
Sample sizes were incident cases/participants for cohort studies, and cases/controls for case–control studies