Autism spectrum disorder (ASD) prevalence has increased over several decades to its current estimatedprevalence of 1.5% among 8-year-old children in the United States. Recent research suggests that adversechild neurodevelopmental outcomes, including ASD, may occur in association with maternal obesity anddiabetes during pregnancy. Both obesity and diabetes mellitus among women of reproductive age have beenincreasing and could contribute to the increase in ASD prevalence. Moreover, ambient air pollution (AP), aubiquitous urban environmental exposure, has been associated with diabetes, including a small number ofstudies of gestational diabetes mellitus (GDM), and with ASD. Furthermore, there is growing evidence of otherneurotoxic effects of AP and potential overlapping biological mechanisms for effects of AP and diabetes.However, there are few prospective population-based studies with high quality outcome and exposure datathat have addressed the relationship between AP, GDM, and ASD, and results have not been consistent. Theproposed study’s main objective is to assess the relationship of AP to GDM and ASD, including effects of jointexposure to AP and GDM on ASD, using data from a large Kaiser Permanente Southern California (KPSC)pregnancy cohort study that showed that maternal GDM was associated with ASD. The aims are: 1) toevaluate the association between prenatal exposure to AP and ASD risk; 2) to examine whether prenatalexposure to AP is also associated with GDM; and 3) to assess whether GDM modifies or mediates theassociation between prenatal exposure to AP and ASD risk. These aims will be addressed using electronicmedical records data from the existing cohort of children born in KPSC hospitals between 1995 and 2013.Gestational and early life exposure to traffic density and residential proximity to major roadways (markers forthe near-roadway air pollution mixture), and to regional particulate and gaseous air pollutants will be estimatedfor approximately 80,000 mother-offspring pairs using a low-cost procedure developed by the National Instituteof Environmental Health Sciences (NIEHS)-supported Southern California Environmental Health SciencesCenter. Both Cox regression and logistic regression models will be used to examine the associations of AP,GDM, and ASD. The proposed training plan will result in depth of knowledge of neuroepidemiology,specifically ASD, AP exposure assessment, and of statistical analyses necessary for a career as anindependent investigator conducting interdisciplinary epidemiologic research on environmental factorscontributing to pediatric neurological disorders. The study addresses the NIEHS goal to understand the effectsof environmental factors during vulnerable periods that increase the risk of ASD. Furthermore, this study hasthe potential to address gaps in our understanding of the effects of role of AP in GDM and ASD. AP and GDMare common risk factors amenable to intervention targeting public policy and behavior.
Interagency Autism Coordinating Committee (IACC)
Autism Research Database (AFD)
