A retrospective study of more than 224,000 children born in the Kaiser Permanente Northern California health system found that maternal health conditions during pregnancy were consistently associated with autism spectrum disorder across racial and ethnic groups. Overall, 2.4% of children in the cohort were diagnosed with autism, with prevalence ranging from 2.0% in white children to 3.2% in Black children. The study, published in JAMA Network Open, assessed 25 maternal diagnoses previously linked to autism.
Four conditions—maternal overweight and obesity, depression, asthma, and pregnancy complications—showed significant racial and ethnic differences in the strength of their association with autism. All four had stronger associations in white mothers than in Black, Hispanic, or Asian and Pacific Islander mothers. The authors noted that these differences could reflect disparities in healthcare access, diagnostic practices, or unmeasured environmental and genetic factors rather than true biological variation.
An accompanying editorial by Aisha Dickerson of Johns Hopkins Bloomberg School of Public Health pointed out that electronic health records, while useful for large-scale studies, still require healthcare access. She argued that the findings support the idea that mothers from historically marginalized populations may experience healthcare disparities and lower diagnostic ascertainment for adverse health conditions. The study's limitations include a finite follow-up period, which may miss autism diagnoses made at later ages, and the possibility that other dimensions beyond race and ethnicity contribute to the observed patterns.