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Parental asthma and risk of autism spectrum disorder in offspring: a population and family based case-control study
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Woolcock Insitute of Medical Research, University of Sydney, Australia.
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Obstetrics and Gynaecology Unit Södersjukhuset, Stockholm, Sweden.
Center of Neurodevelopmental Disorders at Karolinska Institutet (KIND), Center for Psychiatric Research; Department of Women's & Children's Health, Karolinska Institutet & Child and Adolescent Psychiatry, Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden; Curtin Autism Research Group, School of Occupational Therapy, Social Work and Speech Pathology, Curtin University, Perth, Western, Australia.
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2019 (English)In: Clinical and Experimental Allergy, ISSN 0954-7894, E-ISSN 1365-2222, Vol. 49, no 6, p. 883-891Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Associations between parental asthma and prenatal exposure to asthma medications with offspring autism spectrum disorder (ASD) have been reported. However, the associations might be confounded by unmeasured (genetic and shared environmental) familial factors.

OBJECTIVE: We investigated the association between (a) maternal/paternal asthma and offspring ASD, and (b) prenatal exposures to β2-agonists, other asthma medications and offspring ASD using cases and controls selected from the population as well as biological relatives with different degrees of relatedness.

METHODS: We included all children (N=1,579,263) born in Sweden 1992-2007. A nested case-control design was used to compare 22,894 ASD cases identified from the National Patient Register to (i) 228,940 age-, county- and sex-matched controls randomly selected from the population, (ii) their eligible full-siblings (n=1,267), (iii) half-siblings (n=1,323), (iv) full-cousins (n=11,477), and (v) half-cousins (n=3,337). Conditional logistic regression was used to estimate the odds ratios (OR) and 95% confidence intervals (CI) for ASD in children differentially exposed to parental asthma or prenatal asthma medications.

RESULTS: Maternal asthma was associated with increased risk of offspring ASD (OR 1.43, 95% CI 1.38-1.49); there was a weaker association for paternal asthma (OR 1.17, 95% CI 1.11-1.23). The risk of offspring ASD in mothers with asthma showed similar estimates when adjusting for shared familial factors among paternal half-siblings (OR 1.20, 95% CI 0.80-1.81), full-cousins (OR 1.28, 95% CI 1.16-1.41), and half-cousins (OR 1.30, 95% CI 1.10-1.54), albeit with wider confidence intervals. Prenatal exposure to asthma medications among subjects whose mothers had asthma was not associated with subsequent ASD.

CONCLUSIONS AND CLINICAL RELEVANCE: In this large observational study, parental asthma was associated with slightly elevated risk of ASD in offspring. More specifically, the increased risk by maternal asthma did not seem to be confounded by familial factors. There was no evidence of an association between asthma medications during pregnancy and offspring ASD.

Place, publisher, year, edition, pages
Blackwell Science Ltd. , 2019. Vol. 49, no 6, p. 883-891
Keywords [en]
Asthma, autism spectrum disorder, confounding, medications during pregnancy, nested case-control
National Category
Respiratory Medicine and Allergy
Identifiers
URN: urn:nbn:se:oru:diva-72475DOI: 10.1111/cea.13353ISI: 000475694600016PubMedID: 30742718Scopus ID: 2-s2.0-85062347380OAI: oai:DiVA.org:oru-72475DiVA, id: diva2:1288883
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2015-00289Swedish Research Council, 340-2013-5867Stockholm County CouncilSwedish Heart Lung Foundation
Note

Funding Agency:

HKH Kronprinsessan Lovisas förening for barnasjukvård

Available from: 2019-02-14 Created: 2019-02-14 Last updated: 2019-08-12Bibliographically approved

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