{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T17:08:35Z","timestamp":1792084115465,"version":"4.4.0"},"reference-count":47,"publisher":"Georg Thieme Verlag KG","issue":"03","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Am J Perinatol"],"published-print":{"date-parts":[[2021,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>\n          Objective\u2003This study aimed to determine if hyperemesis gravidarum (HG) is associated with autism spectrum disorder (ASD) risk, and how this association is influenced by race, ethnicity, sex, exposure timing, and medication used to treat it.<\/jats:p><jats:p>\n          Study Design\u2003This is a retrospective cohort study using records from 469,789 mother\u2013child pairs who delivered at Kaiser Permanente Southern California (KPSC) hospital (1991\u20132014). Singleton-born children were followed longitudinally from 2 to 17 years of age. Clinical records were used to determine the diagnosis of HG and specialist-confirmed diagnosis of ASD.<\/jats:p><jats:p>\n          Results\u2003Children exposed to HG in-utero had higher rates of ASD than unexposed children (2.87 vs. 1.71\/1,000 person-years; adjusted hazard ratio [adj.HR]: 1.53; 95% confidence interval [CI]: 1.37\u20131.70). Children exposed at first and second trimester of pregnancies were more likely to develop ASD; 1.58-fold (95% CI: 1.40\u20131.79), and 1.36-fold (95% CI: 1.05\u20131.75), respectively, compared with unexposed children. HG was associated with ASD for boys (adj.HR: 1.50; 95% CI: 1.33\u20131.70) and girls (adj.HR: 1.62; 95% CI: 1.28\u20132.05). HG was significantly associated with ASD risk in white and Hispanic children. The medications used to treat HG did not contribute to ASD risk.<\/jats:p><jats:p>\n          Conclusion\u2003HG diagnosis is associated with ASD risk and may be helpful in identifying at-risk children who could benefit from enhanced surveillance and earlier diagnosis and intervention.<\/jats:p>","DOI":"10.1055\/s-0039-1696670","type":"journal-article","created":{"date-parts":[[2019,10,3]],"date-time":"2019-10-03T22:38:54Z","timestamp":1570142334000},"page":"265-272","source":"Crossref","is-referenced-by-count":27,"title":["Autism Spectrum Disorders in Children Exposed in Utero to Hyperemesis Gravidarum"],"prefix":"10.1055","volume":"38","author":[{"given":"Darios","family":"Getahun","sequence":"additional","affiliation":[{"name":"Department of Research and Evaluation, Kaiser Permanente, Southern California, Pasadena"},{"name":"Department of Obstetrics, Gynecology, and Reproductive Sciences, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael J.","family":"Fassett","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Kaiser Permanente West Los Angeles Medical Center, Los Angeles, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven J.","family":"Jacobsen","sequence":"additional","affiliation":[{"name":"Department of Research and Evaluation, Kaiser Permanente, Southern California, Pasadena"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anny H.","family":"Xiang","sequence":"additional","affiliation":[{"name":"Department of Research and Evaluation, Kaiser Permanente, Southern California, Pasadena"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harpreet S.","family":"Takhar","sequence":"additional","affiliation":[{"name":"Department of Research and Evaluation, Kaiser Permanente, Southern California, Pasadena"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deborah A.","family":"Wing","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, University of California, Irvine, California"},{"name":"Korn Ferry, Los Angeles, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Morgan R.","family":"Peltier","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Winthrop University Hospital Research Institute, Winthrop University Hospital, Mineola, New York"},{"name":"Department of Obstetrics and Gynecology, Winthrop University Hospital, Mineola, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2019,10,3]]},"reference":[{"issue":"06","key":"ref1","doi-asserted-by":"crossref","first-page":"1","DOI":"10.15585\/mmwr.ss6706a1","article-title":"Morbidity and mortality weekly report. Prevalence of autism spectrum disorder among children aged 8 years \u2014 Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2014","volume":"67","author":"J Baio","year":"2018","journal-title":"Surveillance Summaries"},{"key":"ref2","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1146\/annurev.publhealth.28.021406.144007","article-title":"The epidemiology of autism spectrum disorders","volume":"28","author":"C J Newschaffer","year":"2007","journal-title":"Annu Rev Public Health"},{"issue":"03","key":"ref3","first-page":"1","article-title":"Prevalence of autism spectrum disorders--Autism and Developmental Disabilities Monitoring Network, 14 sites, United States, 2008","volume":"61","author":"J Biao","year":"2012","journal-title":"MMWR Surveill Summ"},{"issue":"04","key":"ref4","doi-asserted-by":"crossref","first-page":"e821","DOI":"10.1542\/peds.2007-1594","article-title":"Association of childhood autism spectrum disorders and loss of family income","volume":"121","author":"G Montes","year":"2008","journal-title":"Pediatrics"},{"issue":"03","key":"ref5","doi-asserted-by":"crossref","first-page":"e520","DOI":"10.1542\/peds.2013-0763","article-title":"Economic burden of childhood autism spectrum disorders","volume":"133","author":"T A Lavelle","year":"2014","journal-title":"Pediatrics"},{"issue":"03","key":"ref6","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1023\/A:1015405914950","article-title":"Descriptive epidemiology of autism in a California population: who is at risk?","volume":"32","author":"L A Croen","year":"2002","journal-title":"J Autism Dev Disord"},{"issue":"05","key":"ref7","doi-asserted-by":"crossref","first-page":"1395","DOI":"10.1542\/peds.2009-1522","article-title":"Prevalence of parent-reported diagnosis of autism spectrum disorder among children in the US, 2007","volume":"124","author":"M D Kogan","year":"2009","journal-title":"Pediatrics"},{"issue":"11","key":"ref8","doi-asserted-by":"crossref","first-page":"1268","DOI":"10.1093\/aje\/kwn250","article-title":"Advanced parental age and the risk of autism spectrum disorder","volume":"168","author":"M S Durkin","year":"2008","journal-title":"Am J Epidemiol"},{"issue":"14","key":"ref9","doi-asserted-by":"crossref","first-page":"1425","DOI":"10.1001\/jama.2015.2707","article-title":"Association of maternal diabetes with autism in offspring","volume":"313","author":"A H Xiang","year":"2015","journal-title":"JAMA"},{"issue":"03","key":"ref10","doi-asserted-by":"crossref","first-page":"295","DOI":"10.1055\/s-0036-1597624","article-title":"Association of perinatal risk factors with autism spectrum disorder","volume":"34","author":"D Getahun","year":"2017","journal-title":"Am J Perinatol"},{"issue":"06","key":"ref11","doi-asserted-by":"crossref","first-page":"1281","DOI":"10.1016\/j.clinph.2007.12.021","article-title":"Long-term 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A comparison of single and multiple admissions","volume":"36","author":"R K Godsey","year":"1991","journal-title":"J Reprod Med"},{"issue":"01","key":"ref20","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1016\/j.ejogrb.2008.07.003","article-title":"High prevalence of severe nausea and vomiting of pregnancy and hyperemesis gravidarum among relatives of affected individuals","volume":"141","author":"M S Fejzo","year":"2008","journal-title":"Eur J Obstet Gynecol Reprod Biol"},{"issue":"05","key":"ref21","doi-asserted-by":"crossref","first-page":"425","DOI":"10.1089\/thy.1995.5.425","article-title":"Thyrotropic action of human chorionic gonadotropin","volume":"5","author":"M Yoshimura","year":"1995","journal-title":"Thyroid"},{"issue":"01","key":"ref22","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1046\/j.1471-0528.2003.00005.x","article-title":"The sex ratio of pregnancies complicated by hospitalisation for hyperemesis gravidarum","volume":"111","author":"M A Schiff","year":"2004","journal-title":"BJOG"},{"issue":"04","key":"ref23","doi-asserted-by":"crossref","first-page":"412\u2013415","DOI":"10.1016\/j.ajog.2007.09.029","article-title":"Hyperemesis gravidarum that requires hospitalization and the use of antiemetic drugs in relation to maternal body composition","volume":"198","author":"M Cedergren","year":"2008","journal-title":"Am J Obstet Gynecol"},{"issue":"05","key":"ref24","doi-asserted-by":"crossref","first-page":"601","DOI":"10.1192\/bjp.166.5.601","article-title":"Increased risk of affective disorders in males after second trimester prenatal exposure to the Dutch hunger winter of 1944-45","volume":"166","author":"A S Brown","year":"1995","journal-title":"Br J Psychiatry"},{"issue":"05","key":"ref25","doi-asserted-by":"crossref","first-page":"455","DOI":"10.1001\/jama.282.5.455","article-title":"Prenatal exposure to wartime famine and development of antisocial personality disorder in early adulthood","volume":"282","author":"R Neugebauer","year":"1999","journal-title":"JAMA"},{"issue":"05","key":"ref26","doi-asserted-by":"crossref","first-page":"733","DOI":"10.1002\/ana.23976","article-title":"Association of gestational maternal hypothyroxinemia and increased autism risk","volume":"74","author":"G C Rom\u00e1n","year":"2013","journal-title":"Ann Neurol"},{"key":"ref27","first-page":"1","article-title":"Accuracy of reporting maternal and infant perinatal service system coding and clinical utilization coding","author":"D Getahun","year":"2013","journal-title":"J Med Stat Inform"},{"key":"ref28","volume-title":"Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision (DSM-IV-TR)","year":"2000"},{"issue":"07","key":"ref29","doi-asserted-by":"crossref","first-page":"1989","DOI":"10.1007\/s10803-015-2358-0","article-title":"Validation of autism spectrum disorder diagnoses in large healthcare systems with electronic medical records","volume":"45","author":"K J Coleman","year":"2015","journal-title":"J Autism Dev Disord"},{"issue":"02","key":"ref31","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1023\/A:1010738829569","article-title":"The modified checklist for autism in toddlers: an initial study investigating the early detection of autism and pervasive developmental disorders","volume":"31","author":"D L Robins","year":"2001","journal-title":"J Autism Dev Disord"},{"issue":"04","key":"ref32","doi-asserted-by":"crossref","first-page":"268","DOI":"10.7326\/M16-2607","article-title":"Sensitivity Analysis in Observational Research: Introducing the E-Value","volume":"167","author":"T J VanderWeele","year":"2017","journal-title":"Ann Intern Med"},{"key":"ref33","volume-title":"Famine and Human Development. The Dutch Hunger Winter of 1944\u20131945","author":"Z Stein","year":"1975"},{"issue":"02","key":"ref34","doi-asserted-by":"crossref","first-page":"190","DOI":"10.1176\/appi.ajp.157.2.190","article-title":"Further evidence of relation between prenatal famine and major affective disorder","volume":"157","author":"A S Brown","year":"2000","journal-title":"Am J Psychiatry"},{"issue":"07","key":"ref35","doi-asserted-by":"crossref","first-page":"1170","DOI":"10.1176\/appi.ajp.157.7.1170","article-title":"Prenatal exposure to famine and brain morphology in schizophrenia","volume":"157","author":"H E Hulshoff Pol","year":"2000","journal-title":"Am J Psychiatry"},{"issue":"07","key":"ref36","doi-asserted-by":"crossref","first-page":"1025","DOI":"10.1111\/1469-7610.00187","article-title":"Maternal antenatal anxiety and behavioural\/emotional problems in children: a test of a programming hypothesis","volume":"44","author":"T G O'Connor","year":"2003","journal-title":"J Child Psychol Psychiatry"},{"issue":"01","key":"ref37","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1016\/S0149-7634(05)80234-9","article-title":"Prenatal malnutrition and development of the brain","volume":"17","author":"P J Morgane","year":"1993","journal-title":"Neurosci Biobehav Rev"},{"key":"ref38","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1016\/j.bbi.2014.03.021","article-title":"Nutritional n-3 PUFAs deficiency during perinatal periods alters brain innate immune system and neuronal plasticity-associated genes","volume":"41","author":"C Madore","year":"2014","journal-title":"Brain Behav Immun"},{"issue":"05","key":"ref39","doi-asserted-by":"crossref","first-page":"541","DOI":"10.1111\/1471-0528.12132","article-title":"Hyperemesis gravidarum and risks of placental dysfunction disorders: a population-based cohort study","volume":"120","author":"M Bolin","year":"2013","journal-title":"BJOG"},{"issue":"09","key":"ref40","doi-asserted-by":"crossref","first-page":"785","DOI":"10.1016\/j.placenta.2010.06.008","article-title":"Placental BDNF\/TrkB signaling system is modulated by fetal growth disturbances in rat and human","volume":"31","author":"S Mayeur","year":"2010","journal-title":"Placenta"},{"issue":"39","key":"ref41","doi-asserted-by":"crossref","first-page":"16881","DOI":"10.1073\/pnas.1009459107","article-title":"Prenatal undernutrition and cognitive function in late adulthood","volume":"107","author":"S R de Rooij","year":"2010","journal-title":"Proc Natl Acad Sci U S A"},{"issue":"03","key":"ref42","doi-asserted-by":"crossref","first-page":"497","DOI":"10.1007\/s12020-014-0169-2","article-title":"Maternal diabetes affects rat placental morphology and pregnancy","volume":"45","author":"P S Farias","year":"2014","journal-title":"Endocrine"},{"issue":"04","key":"ref43","doi-asserted-by":"crossref","first-page":"546","DOI":"10.1203\/00006450-199810000-00013","article-title":"Influence of restricted maternal nutrition in early to mid gestation on placental and fetal development at term in sheep","volume":"44","author":"L Heasman","year":"1998","journal-title":"Pediatr Res"},{"issue":"36","key":"ref44","doi-asserted-by":"crossref","first-page":"12802","DOI":"10.1523\/JNEUROSCI.0898-11.2011","article-title":"Pitx3 is a critical mediator of GDNF-induced BDNF expression in nigrostriatal dopaminergic neurons","volume":"31","author":"C Peng","year":"2011","journal-title":"J Neurosci"},{"issue":"05","key":"ref45","doi-asserted-by":"crossref","first-page":"292","DOI":"10.1016\/S0387-7604(03)00168-2","article-title":"Serum neurotrophin concentrations in autism and mental retardation: a pilot study","volume":"26","author":"K Miyazaki","year":"2004","journal-title":"Brain 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