Association of gestational maternal hypothyroxinemia and increased autism risk
Article first published online: 13 AUG 2013
© 2013 The Authors. Annals of Neurology published by Wiley Periodicals, Inc. on behalf of the American Neurological Association.
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Annals of Neurology
Volume 74, Issue 5, pages 733–742, November 2013
How to Cite
Román, G. C., Ghassabian, A., Bongers-Schokking, J. J., Jaddoe, V. W. V., Hofman, A., de Rijke, Y. B., Verhulst, F. C. and Tiemeier, H. (2013), Association of gestational maternal hypothyroxinemia and increased autism risk. Ann Neurol., 74: 733–742. doi: 10.1002/ana.23976
- Issue published online: 18 DEC 2013
- Article first published online: 13 AUG 2013
- Manuscript Accepted: 3 JUL 2013
- Manuscript Revised: 21 JUN 2013
- Manuscript Received: 19 MAR 2013
Transient gestational hypothyroxinemia in rodents induces cortical neuronal migration brain lesions resembling those of autism. We investigated the association between maternal hypothyroxinemia (gestational weeks 6–18) and autistic symptoms in children.
The mother-and-child cohort of the Generation R Study (Rotterdam, the Netherlands) began prenatal enrollment between 2002 and 2006. At a mean gestational age of 13.4 weeks (standard deviation = 1.9, range = 5.9–17.9), maternal thyroid function tests (serum thyrotropin [TSH], free thyroxine [fT4], and thyroid peroxidase [TPO] antibodies) were assessed in 5,100 women. We defined severe maternal hypothyroxinemia as fT4 < 5th percentile with normal TSH. Six years later, parents reported behavioral and emotional symptoms in 4,039 children (79%) using the Pervasive Developmental Problems (PDP) subscale of the Child Behavior Checklist and/or the Social Responsiveness Scale (SRS). We defined a probable autistic child by a PDP score > 98th percentile and SRS score in the top 5% of the sample (n = 81, 2.0%).
Severe maternal hypothyroxinemia (n = 136) was associated with an almost 4-fold increase in the odds of having a probable autistic child (adjusted odds ratio = 3.89, 95% confidence interval [CI] = 1.83–8.20, p < 0.001). Using PDP scores, children of mothers with severe hypothyroxinemia had higher scores of autistic symptoms by age 6 years (adjusted B = 0.23, 95% CI = 0.03–0.37); SRS results were similar. No risk was found for children of TPO-antibody–positive mothers (n = 308).
We found a consistent association between severe, early gestation maternal hypothyroxinemia and autistic symptoms in offspring. Findings are concordant with epidemiological, biological, and experimental data on autism. Although these findings cannot establish causality, they open the possibility of preventive interventions. Ann Neurol 2013;74:733–742