Association between parental body mass index and autism spectrum disorder: a systematic review and meta-analysis


Studies have examined the association between parental body mass index (BMI) and autism spectrum disorder (ASD) in offspring, with inconsistent results, especially regarding maternal obesity, overweight and underweight. Cochrane Library, EMBASE, PubMed and PsycINFO databases were searched up to March 2018 for relevant observational studies with no language restriction. Our literature search identified 13 eligible studies for meta-analysis (involving 943,293 children and 30,337 cases). For maternal BMI (13 studies), both maternal obesity [OR 1.41 (95% CI 1.19–1.67)] and maternal overweight [OR 1.16 (95% CI 1.05–1.27)] were significantly associated with ASD, while maternal underweight was not associated with ASD [OR 1.08 (95% CI 0.98–1.20)]. For paternal BMI (three studies), no association was found (paternal obesity: OR 1.28, 95% CI 0.94–1.74; overweight: OR 1.07, 95% CI 0.99–1.15; underweight: OR 1.12, 95% CI 0.87–1.44). Pooled estimates were robust in sensitivity analysis and subgroup analyses. Publication bias may exist for studies assessing maternal BMI and ASD risk, but the filled estimates were not altered. Relative to normal weight, maternal obesity and overweight were significantly associated with increased ASD risk, while maternal underweight was not associated with ASD. Although no association between paternal BMI and ASD was found, current evidence is limited (three studies). Future studies are warranted to address more confounding factors and to identify potential mediators of the association, but pre-pregnancy weight control is suggested.

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  1. 1.

    American Psychiatric Association (2013) Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub, Washington, DC

    Google Scholar 

  2. 2.

    Christensen DL, Bilder DA, Zahorodny W, Pettygrove S, Durkin MS, Fitzgerald RT et al (2016) Prevalence and characteristics of autism spectrum disorder among 4-year-old children in the autism and developmental disabilities monitoring network. J Devel Behav Pediatr 37(1):1–8

    Article  Google Scholar 

  3. 3.

    Gaugler T, Klei L, Sanders SJ, Bodea CA, Goldberg AP, Lee AB et al (2014) Most genetic risk for autism resides with common variation. Nat Genet 46(8):881–885

    CAS  Article  Google Scholar 

  4. 4.

    Deng WL, Zou XB, Deng HZ, Li JY, Tang C, Wang XQ et al (2015) The relationship among genetic heritability, environmental effects, and autism spectrum disorders: 37 pairs of ascertained twin study. J Child Neurol 30(13):1794–1799

    Article  Google Scholar 

  5. 5.

    Kim YS, Leventhal BL (2015) Genetic epidemiology and insights into interactive genetic and environmental effects in autism spectrum disorders. Biol Psychiat 77(1):66–74

    CAS  Article  Google Scholar 

  6. 6.

    Landrigan PJ (2010) What causes autism? Exploring the environmental contribution. Curr Opin Pediatr 22(2):219–225

    Article  Google Scholar 

  7. 7.

    Modabbernia A, Velthorst E, Reichenberg A (2017) Environmental risk factors for autism: an evidence-based review of systematic reviews and meta-analyses. Mol Autism 8(1):13

    Article  Google Scholar 

  8. 8.

    Flegal KM, Kruszon-Moran D, Carroll MD, Fryar CD, Ogden CL (2016) Trends in obesity among adults in the United States, 2005 to 2014. JAMA 315(21):2284–2291

    CAS  Article  Google Scholar 

  9. 9.

    Poston L, Caleyachetty R, Cnattingius S, Corvalán C, Uauy R, Herring S et al (2016) Preconceptional and maternal obesity: epidemiology and health consequences. Lancet Diabetes Endo 4(12):1025–1036

    Article  Google Scholar 

  10. 10.

    Godfrey KM, Reynolds RM, Prescott SL, Nyirenda M, Jaddoe VW, Eriksson JG et al (2017) Influence of maternal obesity on the long-term health of offspring. Lancet Diabetes Endo 5(1):53–64

    Article  Google Scholar 

  11. 11.

    Lyall K, Pauls DL, Santangelo S, Spiegelman D, Ascherio A (2011) Maternal early life factors associated with hormone levels and the risk of having a child with an autism spectrum disorder in the nurses health study II. J Autism Dev Disord 41(5):618–627

    Article  Google Scholar 

  12. 12.

    Krakowiak P, Walker CK, Bremer AA, Baker AS, Ozonoff S, Hansen RL et al (2012) Maternal metabolic conditions and risk for autism and other neurodevelopmental disorders. Pediatrics 129(5):e1121–e1128

    Article  Google Scholar 

  13. 13.

    Moss BG, Chugani DC (2014) Increased risk of very low birth weight, rapid postnatal growth, and autism in underweight and obese mothers. Am J Health Promo 28(3):181–188

    Article  Google Scholar 

  14. 14.

    Surén P, Gunnes N, Roth C, Bresnahan M, Hornig M, Hirtz D et al (2014) Parental obesity and risk of autism spectrum disorder. Pediatrics peds:2013–3664

    Google Scholar 

  15. 15.

    Reynolds LC, Inder TE, Neil JJ, Pineda RG, Rogers CE (2014) Maternal obesity and increased risk for autism and developmental delay among very preterm infants. J Perinatol 34(9):688

    CAS  Article  Google Scholar 

  16. 16.

    Xiang AH, Wang X, Martinez MP, Walthall JC, Curry ES, Page K et al (2015) Association of maternal diabetes with autism in offspring. JAMA 313(14):1425–1434

    CAS  Article  Google Scholar 

  17. 17.

    Gardner RM, Lee BK, Magnusson C, Rai D, Frisell T, Karlsson H et al (2015) Maternal body mass index during early pregnancy, gestational weight gain, and risk of autism spectrum disorders: results from a Swedish total population and discordant sibling study. Int J Epidemiol 44(3):870–883

    Article  Google Scholar 

  18. 18.

    Connolly N, Anixt J, Manning P, Ping-I Lin D, Marsolo KA, Bowers K (2016) Maternal metabolic risk factors for autism spectrum disorder—An analysis of electronic medical records and linked birth data. Autism Res 9(8):829–837

    Article  Google Scholar 

  19. 19.

    Getz KD, Anderka MT, Werler MM, Jick SS (2016) Maternal pre-pregnancy body mass index and autism spectrum disorder among offspring: a population-based case–control study. Paediatr Perinat Epidemiol 30(5):479–487

    Article  Google Scholar 

  20. 20.

    Casas M, Forns J, Martínez D, Guxens M, Fernandez-Somoano A, Ibarluzea J et al (2017) Maternal pre-pregnancy obesity and neuropsychological development in pre-school children: a prospective cohort study. Pediatr Res 82(4):596

    Article  Google Scholar 

  21. 21.

    Andersen CH, Thomsen PH, Nohr EA, Lemcke S (2018) Maternal body mass index before pregnancy as a risk factor for ADHD and autism in children. Eur Child Adoles Psychiatry 27(2):139–148

    Article  Google Scholar 

  22. 22.

    Li M, Fallin MD, Riley A, Landa R, Walker SO, Silverstein M et al (2016) The association of maternal obesity and diabetes with autism and other developmental disabilities. Pediatrics 137(2):e20152206

    Article  Google Scholar 

  23. 23.

    Ling Z, Wang J, Li X, Zhong Y, Qin Y, Xie S et al (2015) Association between mothers’ body mass index before pregnancy or weight gain during pregnancy and autism in children. Zhonghua liuxingbingxue zazhi 36(9):949–952

    PubMed  Google Scholar 

  24. 24.

    Li Y-M, Ou J-J, Liu L, Zhang D, Zhao J-P, Tang S-Y (2016) Association between maternal obesity and autism spectrum disorder in offspring: a meta-analysis. J Autism Dev Disord 46(1):95–102

    Article  Google Scholar 

  25. 25.

    Wells G, Shea B, O’connell D, Peterson J, Welch V, Losos M, et al (2013) The Newcastle–Ottawa Scale (NOS) for assessing the quality if nonrandomized studies in meta-analyses. 2009. htm. Accessed 19 Oct 2009

  26. 26.

    Higgins JP, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta-analyses. BMJ 327(7414):557

    Article  Google Scholar 

  27. 27.

    Duval S, Tweedie R (2000) Trim and fill: a simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis. Biometrics 56(2):455–463

    CAS  Article  Google Scholar 

  28. 28.

    Gardener H, Spiegelman D, Buka SL (2009) Prenatal risk factors for autism: comprehensive meta-analysis. Br J Psychiatry 195(1):7–14

    Article  Google Scholar 

  29. 29.

    Gardener H, Spiegelman D, Buka SL (2011) Perinatal and neonatal risk factors for autism: a comprehensive meta-analysis. Pediatrics 128(2):344–355

    Article  Google Scholar 

  30. 30.

    Wu S, Wu F, Ding Y, Hou J, Bi J, Zhang Z (2017) Advanced parental age and autism risk in children: a systematic review and meta-analysis. Acta Psychiat Scand 135(1):29–41

    CAS  Article  Google Scholar 

  31. 31.

    Van Der Linden EL, Browne JL, Vissers KM, Antwi E, Agyepong IA, Grobbee DE et al (2016) Maternal body mass index and adverse pregnancy outcomes: a ghanaian cohort study. Obesity 24(1):215–222

    Article  Google Scholar 

  32. 32.

    Aune D, Saugstad OD, Henriksen T, Tonstad S (2014) Maternal body mass index and the risk of fetal death, stillbirth, and infant death: a systematic review and meta-analysis. JAMA 311(15):1536–1546

    CAS  Article  Google Scholar 

  33. 33.

    Schummers L, Hutcheon JA, Bodnar LM, Lieberman E, Himes KP (2015) Risk of adverse pregnancy outcomes by prepregnancy body mass index: a population-based study to inform prepregnancy weight loss counseling. Obstet Gynecol 125(1):133–143

    Article  Google Scholar 

  34. 34.

    Lutsiv O, Mah J, Beyene J, McDonald SD (2015) The effects of morbid obesity on maternal and neonatal health outcomes: a systematic review and meta-analyses. Obes Rev 16(7):531–546

    CAS  Article  Google Scholar 

  35. 35.

    Madan JC, Davis JM, Craig WY, Collins M, Allan W, Quinn R et al (2009) Maternal obesity and markers of inflammation in pregnancy. Cytokine 47(1):61–64

    CAS  Article  Google Scholar 

  36. 36.

    van der Burg JW, Sen S, Chomitz VR, Seidell JC, Leviton A, Dammann O (2016) The role of systemic inflammation linking maternal body mass index to neurodevelopment in children: inflammation and neurodevelopment. Pediatr Res 79(1–1):3

    Article  Google Scholar 

  37. 37.

    Buehler M (2011) A proposed mechanism for autism: an aberrant neuroimmune response manifested as a psychiatric disorder. Med Hypotheses 76(6):863–870

    CAS  Article  Google Scholar 

  38. 38.

    Edlow AG, Vora NL, Hui L, Wick HC, Cowan JM, Bianchi DW (2014) Maternal obesity affects fetal neurodevelopmental and metabolic gene expression: a pilot study. Plos One 9(2):88661

    Article  Google Scholar 

  39. 39.

    Georgieff MK, Brunette KE, Tran PV (2015) Early life nutrition and neural plasticity. Dev Psychopathol 27(2):411–423

    Article  Google Scholar 

  40. 40.

    Curran EA, O’Keeffe GW, Looney AM, Moloney G, Hegarty SV, Murray DM et al (2017) Exposure to hypertensive disorders of pregnancy increases the risk of autism spectrum disorder in affected offspring. Mol Neurobiol 5:1–8

    Google Scholar 

  41. 41.

    Lyall K, Munger KL, O’Reilly ÉJ, Santangelo SL, Ascherio A (2013) Maternal dietary fat intake in association with autism spectrum disorders. Am J Epidemiol 178(2):209–220

    Article  Google Scholar 

  42. 42.

    Xu G, Jing J, Bowers K, Liu B, Bao W (2014) Maternal diabetes and the risk of autism spectrum disorders in the offspring: a systematic review and meta-analysis. J Autism Dev Disord 44(4):766–775

    Article  Google Scholar 

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The authors are supported by the National Natural Science Foundation of China (No: 81873806).

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Correspondence to Ya-Min Li.

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No patients were involved in the design, conduct or interpretation of our review.

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Lei, XY., Li, YJ., Ou, JJ. et al. Association between parental body mass index and autism spectrum disorder: a systematic review and meta-analysis. Eur Child Adolesc Psychiatry 28, 933–947 (2019).

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  • Body mass index
  • Pre-pregnancy
  • Autism spectrum disorder
  • Meta-analysis