Optimal interpregnancy interval in autism spectrum disorder: A multi‐national study of a modifiable risk factor

Pereira, Gavin; Francis, Richard W.; Gissler, Mika; Hansen, Stefan N.; Kodesh, Arad; Leonard, Helen; Levine, Stephen Z.; Mitter, Vera; Parner, Erik Thorlund; Regan, Annette K.; Reichenberg, Abraham; Sandin, Sven; Suominen, Auli; Schendel, Diana

doi:10.1002/aur.2599

Cited by 8 publications

(7 citation statements)

References 29 publications

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“…Studies on the association between unintended pregnancy and ASD in toddlers are limited. One important retrospective cohort study conducted in Denmark, Finland, and Sweden indicated that both shorter and longer interpregnancy intervals (IPIs) were associated with an increased risk of ASD (Pereira et al, 2021). Other previous studies also supported the U ‐shaped IPI associations with ASD (Cheslack‐Postava et al, 2014).…”

Section: Discussionmentioning

confidence: 99%

Associations of unintended pregnancy with autism spectrum disorders and the modification of folic acid supplements

Chen,

Liu,

Lin

et al. 2023

Autism Research

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There is limited evidence on the associations of unintended pregnancy with autism spectrum disorders (ASD). This study aimed to examine this relationship and the modification of pre‐conceptional and prenatal folic acid supplements. Six thousand and five toddlers aged 16 to 30 months from seven cities of six provinces in China were eligible for participation. Information on unintended pregnancy and folic acid supplements was obtained via questionnaires from caregivers of toddlers. The diagnosis of ASD was based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM‐5) and the Chinese version of the Childhood Autism Rating Scale (CARS). Of the 6005 toddlers in the study (3337 boys and 2668 girls), 71 (1.18%) received the diagnosis of ASD. Generalized linear models with a logit link function showed unintended pregnancy was positively associated with ASD (odds ratios [OR] = 1.69, 95% confidence interval [CI], 1.05–2.79). Stratified estimates indicated that the association remained stable among toddlers of mothers without pre‐conceptional and prenatal folic acid supplements (OR = 2.75, 95% CI, 1.04–7.27; n = 1243, 20.70%). Unintended pregnancy was associated with higher odds of ASD in 16–30 months of toddlers, and the association was consistent among toddlers of mothers without prenatal folic acid supplements. Our findings emphasize the need to raise awareness of the risk of unintended pregnancy and the benefits of folic acid supplements among Chinese women.

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Section: Discussionmentioning

confidence: 99%

Associations of unintended pregnancy with autism spectrum disorders and the modification of folic acid supplements

Chen,

Liu,

Lin

et al. 2023

Autism Research

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“…Various biological pathways were reported except for maternal-fetal glucose metabolism. Biologically, micronutrient depletion after a short IPI can lead to the degradation of physiological functions and transient nutritional depletion, especially folic acid deficiency, which affects neurodevelopment 27 . And there is substantial evidence linking poor maternal nutrition to brain development in offspring 2 .…”

Section: Discussionmentioning

confidence: 99%

Interpregnancy interval and early neurodevelopment in offspring: A Prospective Birth Cohort Study

Ma¹,

Wang

Yang³

et al. 2022

Preprint

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Objective This study aimed to determine the correlation between interpregnancy interval (IPI) and neurodevelopmental delay in infants and to explore the potential mediating role of maternal-fetal glucose metabolism. Design Population based cohort study. Setting China Participants A total of 2559 mother-infant pairs between 2018 and 2022. Methods The prospective birth cohort study included 2559 mother-infant pairs. The IPI is calculated by subtracting the gestational age of the current pregnancy from the interval at the end of the previous pregnancy. Maternal fasting venous blood collection at 24-28 weeks and cord blood collection at delivery. The association between IPI and neurodevelopment was determined by logistic regression. Main outcome measures Neurodevelopmental outcomes at 12 months in offspring were assessed by the Ages and Stages Questionnaire Edition 3 (ASQ-3). Results In our cohort, 14.0% had an IPI <12 months. IPI <12 months increased the failure of the communication domain, fine motor domain, and personal social domain of the ASQ [relative risks (RRs) with 95% confidence interval (CI): 1.75(1.13, 2.72); 1.77(1.13, 2.77); 1.51(1.01, 2.28)]. Maternal homeostasis model assessment of insulin resistance (HOMA-IR) and cord blood C-peptide was significantly associated with failure in the communication domain [RRs with 95% CI: 1.15(1.02, 1.31); 2.15(1.26, 3.67)]. The proportion of the association between IPI and failure of the communication domain risk mediated by maternal HOMA-IR and cord blood C-peptide was 14.4%. Conclusions IPI <12 months was associated with failing the communication domain in offspring. Maternal-fetal glucose metabolism abnormality may partially explain the neurodevelopmental delay caused by short IPI.

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“…13 Several studies have also found a higher risk of autism in second-born children of pregnancies less than 12 months apart compared with longer intervals of around 36 months. 19 20 21 Recent studies in high-resource settings reported evidence that short IPI is associated with increased risk of precipitous labor and decreased risks of labor dystocia 22 and that adverse perinatal outcomes may be associated with intervals of only less than 6 months. 23 24 In low- and middle-income countries, findings from Demographic and Health Surveys reported IPSs of less than 12 months to be associated with increased risk of stillbirth but with the effects attenuated when considering second and third intervals, suggesting the association in the first interval might not be causal.…”

Section: Key Interventions In Interconception Carementioning

confidence: 99%

Interconception Health: Improving Equitable Access to Pregnancy Planning

Black

Middleton²,

LibSt

et al. 2022

Semin Reprod Med

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Challenges remain with the implementation of preconception care, as many women do not plan their pregnancies and clinicians do not initiate preconception consultations. However, the interconception period may present a more opportune time to address health issues that impact on pregnancy outcomes and may influence future conceptions. It is also an important time to focus on pregnancy complications that may influence a person's health trajectory. This review discusses the evidence pointing to a need for greater attention on interconception health and focuses on five areas of care that may be particularly important in affecting equitable access to good care before a subsequent pregnancy: interpregnancy intervals, contraception, weight, nutrition, and gestational diabetes follow-up. Several programs internationally have developed models of care for interconception health and this review presents one such model developed in the United States that explicitly seeks to reach vulnerable populations of women who may otherwise not receive preconception care.

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Optimal interpregnancy interval in autism spectrum disorder: A multi‐national study of a modifiable risk factor

Cited by 8 publications

References 29 publications

Associations of unintended pregnancy with autism spectrum disorders and the modification of folic acid supplements

Associations of unintended pregnancy with autism spectrum disorders and the modification of folic acid supplements

Interpregnancy interval and early neurodevelopment in offspring: A Prospective Birth Cohort Study

Interconception Health: Improving Equitable Access to Pregnancy Planning

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