Am J Perinatol 2021; 38(03): 265-272
DOI: 10.1055/s-0039-1696670
Original Article

Autism Spectrum Disorders in Children Exposed in Utero to Hyperemesis Gravidarum

Darios Getahun
1   Department of Research and Evaluation, Kaiser Permanente, Southern California, Pasadena
2   Department of Obstetrics, Gynecology, and Reproductive Sciences, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey
Michael J. Fassett
3   Department of Obstetrics and Gynecology, Kaiser Permanente West Los Angeles Medical Center, Los Angeles, California
Steven J. Jacobsen
1   Department of Research and Evaluation, Kaiser Permanente, Southern California, Pasadena
Anny H. Xiang
1   Department of Research and Evaluation, Kaiser Permanente, Southern California, Pasadena
Harpreet S. Takhar
1   Department of Research and Evaluation, Kaiser Permanente, Southern California, Pasadena
Deborah A. Wing
4   Department of Obstetrics and Gynecology, University of California, Irvine, California
5   Korn Ferry, Los Angeles, California
Morgan R. Peltier
6   Department of Obstetrics and Gynecology, Winthrop University Hospital Research Institute, Winthrop University Hospital, Mineola, New York
7   Department of Obstetrics and Gynecology, Winthrop University Hospital, Mineola, New York
› Author Affiliations
Funding This study was supported in part by Kaiser Permanente Direct Community Benefit Funds. The opinions expressed are solely the responsibility of the authors and do not necessarily reflect the official views of the Kaiser Permanente Community Benefit Funds.


Objective This 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.

Study Design This is a retrospective cohort study using records from 469,789 mother–child pairs who delivered at Kaiser Permanente Southern California (KPSC) hospital (1991–2014). 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.

Results Children 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]: 1.37–1.70). Children exposed at first and second trimester of pregnancies were more likely to develop ASD; 1.58-fold (95% CI: 1.40–1.79), and 1.36-fold (95% CI: 1.05–1.75), respectively, compared with unexposed children. HG was associated with ASD for boys (adj.HR: 1.50; 95% CI: 1.33–1.70) and girls (adj.HR: 1.62; 95% CI: 1.28–2.05). HG was significantly associated with ASD risk in white and Hispanic children. The medications used to treat HG did not contribute to ASD risk.

Conclusion HG 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.

Supplementary Material

Publication History

Received: 17 July 2019

Accepted: 26 July 2019

Article published online:
03 October 2019

© 2019. Thieme. All rights reserved.

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