Office of Epidemiology and Research, Division of Research

Advancing Applied MCH Research

A Prospective Birth Cohort Study on Pre- and Peri-natal Determinants of Autism Spectrum Disorders and Developmental Disabilities

Project Number: R40MC27443
Grantee: Johns Hopkins University
Department/Center: Bloomberg School of Public Health/Population, Family & Reproductive Health
Project Date: 9/1/2014
Principal Investigator: Xiaobin Wang

Final Report



  • Women/Maternal
  • Prenatal
  • Perinatal/Infancy (0-12 months)


Problem: Autism Spectrum Disorders (ASD) affects 1 in 68 U.S. children. Early identification and prevention are keys to reducing the population burden of ASD. Growing evidence supports fetal, or even preconception origins of ASD, yet existing findings are mostly derived from casecontrol or retrospective studies. Few adequately powered birth cohort studies have prospectively ascertained early life risk and protective factors for ASD and barriers to early identification. Goals and Objectives: We propose transforming an existing large-scale prospective birth cohort - the Boston Birth Cohort (BBC) - into an ASD cohort to efficiently and immediately investigate preconception, pre- and peri-natal risk factors and health services patterns for ASD. The BBC is a well-established and ongoing prospective birth cohort of a U.S. urban predominantly lowincome minority population, now consisting of over 8,500 mother-infant pairs. Our goal is to examine the independent and combined effects of maternal demographics, medical, psychosocial, home and neighborhood environments at critical developmental windows (preconception, pre- and perinatal) on the risk of ASD and Developmental Disabilities (DD), and to analyze health services patterns in this cohort. Specifically, we will: Aim 1. Transform the BBC into an autism birth cohort through vigorous ASD assessments. Aim 2. Analyze health services utilization among three groups of children (ASD with or without DD; DD only; and typically developing children) in the context of socio-demographic characteristics. Aim 3. Examine the independent and joint effects of preconception and pregnancy-related conditions on the risk of ASD and DD, and on quantitative ASD. Aim 4. Examine maternal psychosocial stressors and their effects on the risk of ASD, DD, and quantitative ASD traits. Aim 5. Provide leadership in education, training and dissemination of relevant ASD and DD research. Methods: We have assembled a trans-disciplinary team with strong track records in relevant fields. We will leverage the ongoing follow-up and field infrastructure of the BBC to perform vigorous ASD and DD assessments through a combination of electronic medical record (EMR) query, universal screening by Social Responsiveness Scale (SRS), and Social Communication Questionnaire (SCQ), and clinical validation. This new information will be merged with the existing extensive BBC databases. As such, we have an exceptional opportunity to efficiently define ASD and DD related traits and address the proposed study aims. The Healthy People 2020 Objective(s): To our knowledge, this would be the first and largest prospective birth cohort study on ASD and DD in a US urban predominantly low-income minority population. We anticipate that important and modifiable early life factors contributing to ASD and DD will be identified. Such information is critically needed to help inform future clinical and public health strategies aimed at identifying high-risk infants, developing costeffective interventions at the earliest possible developmental windows, and transforming the way in which clinical and public health services are organized and delivered.


Listed is descending order by year published.

Brucato M, Ladd-Acosta C, Li M, et al. Prenatal exposure to fever is associated with autism spectrum disorder in the Boston Birth Cohort. Autism Res. Epub ahead of print 2017 August 11.

Bustamante Helfrich B, Chilukuri N, He H, et al. Maternal vascular malperfusion of the placental bed associated with hypertensive disorders in the Boston Birth Cohort. Placenta. 2017;52:106-113.

Mao G, Nachman RM, Sun Q, et al. Individual and joint effects of early-life ambient exposure and maternal prepregnancy obesity on childhood overweight or obesity. Environ Health Perspect. 2017;125(6):067005.

Mueller NT, Mao G, Bennet WL, et al. Does vaginal delivery mitigate or strengthen the intergenerational association of overweight and obesity? Findings from the Boston Birth Cohort. Int J Obes (Lond). 2017;41(4):497-501.

Raghavan R, Riley AW, Volk H, et al. Maternal multivitamin intake, plasma folate and vitamin B12 levels and autism spectrum disorder risk in offspring. Paediatr Perinat Epidemiol. Published Online: October 6, 2017.

Tsai HJ, Surkan PJ, Yu SM, et al. Differential effects of stress and African ancestry on preterm birth and related traits among US born and immigrant black mothers. Medicine (Baltimore). 2017;96(5):e5899.

Wang H, Mueller NT, Li J, et al. Association of maternal plasma folate and cardiometabolic risk factors in pregnancy with elevated blood pressure of offspring in childhood. Am J Hypertens. 2017;30(5):532-540

Wang H, Xu BP, Xu RB, Walker SO, Wang G. Joint effect of maternal plasma homocysteine and prepregnancy obesity on child blood pressure: a prospective birth cohort study. Int J Obes (Lond). 2017;41(9):1447-1453.


Autism, Developmental Disabilities, Perinatal, Preterm, Pregnancy, Stress, Low Birthweight, Preconception Health, Special Health Care Needs, Health Care Utilization, Capacity & Personnel

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