. 2025 Jun;155(6):1938-1951.

doi: 10.1016/j.tjnut.2025.02.025. Epub 2025 Mar 17.

The Association of Prenatal Dietary Factors with Child Autism Diagnosis and Autism-Related Traits Using a Mixtures Approach: Results from the Environmental Influences on Child Health Outcomes Cohort

Megan G Bragg¹, Juliette Rando¹, Kecia N Carroll², Stephanie M Eick³, Margaret R Karagas⁴, Pi-I Lin⁵, Rebecca J Schmidt⁶, Kristen Lyall⁷; ECHO Cohort Consortium

Collaborators, Affiliations

Collaborators

ECHO Cohort Consortium:
P Brian Smith⁸, L Kristin Newby⁹, Linda Adair¹⁰, Lisa P Jacobson¹¹, Diane Catellier¹², Monica McGrath¹¹, Christian Douglas¹², Priya Duggal¹¹, Emily Knapp¹¹, Amii Kress¹¹, Courtney K Blackwell¹³, Maxwell A Mansolf¹³, Jin-Shei Lai¹³, Emily Ho¹³, David Cella¹³, Richard Gershon¹³, Michelle L Macy¹⁴, Suman R Das¹⁵, Jane E Freedman¹⁶, Simon A Mallal¹⁵, John A McLean¹⁷, Ravi V Shah¹⁶, Meghan H Shilts¹⁵, Akram N Alshawabkeh¹⁸, Jose F Cordero¹⁹, John Meeker²⁰, Leonardo Trasande²¹, Carlos A Camargo²², Zhaozhong Zhu²², Ashley F Sullivan²², Dana Dabelea²³, Wei Perng²³, Traci A Bekelman²³, Greta Wilkening²³, Sheryl Magzamen²⁴, Brianna F Moore²³, Anne P Starling²⁵, Deborah J Rinehart²⁶, Daphne Koinis Mitchell²⁷, Viren D'Sa²⁷, Sean Cl Deoni²⁸, Hans-Georg Mueller²⁹, Cristiane S Duarte³⁰, Catherine Monk³¹, Glorisa Canino³², Jonathan Posner³³, Tenneill Murray³⁰, Claudia Lugo-Candelas³⁰, Anne L Dunlop³⁴, Patricia A Brennan³⁵, Christine Hockett³⁶, Amy Elliott³⁷, Assiamira Ferrara³⁸, Lisa A Croen³⁸, Monique M Hedderson³⁸, John Ainsworth³⁹, Leonard B Bacharier⁴⁰, Casper G Bendixsen⁴¹, James E Gern⁴², Diane R Gold⁴³, Tina V Hartert⁴⁴, Daniel J Jackson⁴², Christine C Johnson⁴⁵, Christine Lm Joseph⁴⁵, Meyer Kattan⁴⁶, Gurjit K Khurana Hershey⁴⁷, Robert F Lemanske⁴², Susan V Lynch⁴⁸, Rachel L Miller⁴⁹, George T O'Connor⁵⁰, Carole Ober⁵¹, Dennis Ownby⁴⁵, Katherine Rivera-Spoljaric⁵², Patrick H Ryan⁵³, Christine M Seroogy⁴², Anne Marie Singh⁴², Robert A Wood⁵⁴, Edward M Zoratti⁵⁵, Rima Habre⁵⁶, Shohreh Farzan⁵⁶, Frank D Gilliland⁵⁶, Irva Hertz-Picciotto⁵⁷, Deborah H Bennett⁵⁸, Julie B Schweitzer⁵⁹, Rebecca J Schmidt⁵⁷, Janine M LaSalle⁵⁸, Alison E Hipwell⁶⁰, Kate E Keenan⁶¹, Catherine J Karr⁶², Nicole R Bush⁶³, Kaja Z LeWinn⁶⁴, Sheela Sathyanarayana⁶⁵, Qi Zhao⁶⁶, Frances Tylavsky⁶⁶, Kecia N Carroll⁶⁷, Christine T Loftus⁶⁸, Leslie D Leve⁶⁹, Jody M Ganiban⁷⁰, Jenae M Neiderhiser⁷¹, Scott T Weiss⁷², Augusto A Litonjua⁷³, Cindy T McEvoy⁷⁴, Eliot R Spindel⁷⁵, Robert S Tepper⁷⁶, Craig J Newschaffer⁷⁷, Kristen Lyall⁷⁸, Heather E Volk⁷⁹, Rebecca Landa⁸⁰, Sally Ozonoff⁸¹, Joseph Piven⁸², Heather Hazlett⁸², Juhi Pandey⁸³, Robert Schultz⁸³, Steven Dager⁸⁴, Kelly Botteron⁸⁵, Daniel Messinger⁸⁶, Wendy Stone⁸⁷, Jennifer Ames⁸⁸, Thomas G O'Connor⁸⁹, Richard K Miller⁹⁰, Emily Oken⁹¹, Michele R Hacker⁹², Tamarra James-Todd⁹³, T Michael O'Shea⁹⁴, Rebecca C Fry⁹⁵, Jean A Frazier⁹⁶, Rachana Singh⁹⁷, Caitlin Rollins⁹⁸, Angela Montgomery⁹⁹, Ruben Vaidya¹⁰⁰, Robert M Joseph¹⁰¹, Lisa K Washburn¹⁰², Semsa Gogcu¹⁰³, Kelly Bear¹⁰⁴, Julie V Rollins⁹⁴, Stephen R Hooper¹⁰⁵, Genevieve Taylor¹⁰⁶, Wesley Jackson⁹⁴, Amanda Thompson¹⁰⁷, Julie Daniels¹⁰⁸, Michelle Hernandez¹⁰⁶, Kun Lu¹⁰⁹, Michael Msall¹¹⁰, Madeleine Lenski¹¹¹, Rawad Obeid¹¹², Steven L Pastyrnak¹¹³, Elizabeth Jensen¹¹⁴, Christina Sakai¹¹⁵, Hudson Santos¹¹⁶, Jean M Kerver¹¹⁷, Nigel Paneth¹¹⁷, Charles J Barone¹¹⁸, Michael R Elliott¹¹⁹, Douglas M Ruden¹²⁰, Chris Fussman¹²¹, Julie B Herbstman¹²², Amy Margolis¹²³, Susan L Schantz¹²⁴, Sarah Dee Geiger¹²⁵, Andrea Aguiar¹²⁴, Karen Tabb¹²⁶, Rita Strakovsky¹²⁷, Tracey Woodruff¹²⁸, Rachel Morello-Frosch¹²⁹, Amy Padula¹²⁸, Joseph B Stanford¹³⁰, Christina A Porucznik¹³⁰, Angelo P Giardino¹³¹, Rosalind J Wright¹³², Robert O Wright¹³², Brent Collett¹³³, Nicole Baumann-Blackmore⁴², Ronald Gangnon¹³⁴, Daniel J Jackson⁴², Chris G McKennan¹³⁵, Jo Wilson⁴², Matt Altman¹³⁶, Judy L Aschner¹³⁷, Annemarie Stroustrup¹³⁸, Stephanie L Merhar¹³⁹, Paul E Moore¹⁴⁰, Gloria S Pryhuber¹⁴¹, Mark Hudak¹⁴², Ann Marie Reynolds Lyndaker¹⁴³, Andrea L Lampland¹⁴⁴, Burton Rochelson¹⁴⁵, Sophia Jan¹³⁷, Matthew J Blitz¹⁴⁵, Michelle W Katzow¹³⁸, Zenobia Brown¹⁴⁶, Codruta Chiuzan¹⁴⁷, Timothy Rafael¹⁴⁵, Dawnette Lewis¹⁴⁵, Natalie Meirowitz¹⁴⁵, Brenda Poindexter¹⁴⁸, Tebeb Gebretsadik¹⁴⁹, Sarah Osmundson¹⁵⁰, Jennifer K Straughen⁴⁵, Amy Eapen⁵⁵, Andrea Cassidy-Bushrow⁴⁵, Ganesa Wegienka⁴⁵, Alex Sitarik⁴⁵, Kim Woodcroft⁴⁵, Audrey Urquhart⁴⁵, Albert Levin⁴⁵, Tisa Johnson-Hooper¹¹⁸, Brent Davidson¹⁵¹, Tengfei Ma⁴⁵, Emily S Barrett¹⁵², Martin J Blaser¹⁵³, Maria Gloria Dominguez-Bello¹⁵⁴, Daniel B Horton¹⁵⁵, Manuel Jimenez¹⁵⁶, Todd Rosen¹⁵⁷, Kristy Palomares¹⁵⁸, Lyndsay A Avalos³⁸, Yeyi Zhu³⁸, Kelly J Hunt¹⁵⁹, Roger B Newman¹⁶⁰, Michael S Bloom¹⁶¹, Mallory H Alkis¹⁶⁰, James R Roberts¹⁶², Sunni L Mumford¹⁶³, Heather H Burris¹⁶⁴, Sara B DeMauro¹⁶⁴, Lynn M Yee¹⁶⁵, Aaron Hamvas¹⁶⁶, Antonia F Olidipo¹⁶⁷, Andrew S Haddad¹⁶⁷, Lisa R Eiland¹⁶⁸, Nicole T Spillane¹⁶⁸, Kirin N Suri¹⁶⁹, Stephanie A Fisher¹⁶⁵, Jeffrey A Goldstein¹⁷⁰, Leena B Mithal¹⁷¹, Raye-Ann O DeRegnier¹⁶⁶, Nathalie L Maitre¹⁷², Ruby Hn Nguyen¹⁷³, Meghan M JaKa¹⁷⁴, Abbey C Sidebottom¹⁷⁵, Michael J Paidas¹⁷⁶, JoNell E Potter¹⁷⁷, Natale Ruby¹⁷⁸, Lunthita Duthely¹⁷⁹, Arumugam Jayakumar¹⁷⁷, Karen Young¹⁸⁰, Isabel Maldonado¹⁸¹, Meghan Miller¹⁸², Jonathan L Slaughter¹⁸³, Sarah A Keim¹⁸⁴, Courtney D Lynch¹⁸⁵, Kartik K Venkatesh¹⁸⁵, Kristina W Whitworth¹⁸⁶, Elaine Symanski¹⁸⁶, Thomas F Northrup¹⁸⁷, Hector Mendez-Figueroa¹⁸⁸, Ricardo A Mosquera¹⁸⁹, Margaret R Karagas¹⁹⁰, Juliette C Madan¹⁹¹, Debra M MacKenzie¹⁹², Johnnye L Lewis¹⁹², Brandon J Rennie¹⁹³, Bennett L Leventhal¹⁹⁴, Young Shin Kim¹⁹⁵, Somer Bishop¹⁹⁵, Sara S Nozadi¹⁹², Li Luo¹⁹⁶, Barry M Lester¹⁹⁷, Carmen J Marsit¹⁹⁸, Todd Everson¹⁹⁸, Cynthia M Loncar¹⁹⁹, Elisabeth C McGowan²⁰⁰, Stephen J Sheinkopf²⁰¹, Brian S Carter²⁰², Jennifer Check²⁰³, Jennifer B Helderman²⁰³, Charles R Neal²⁰⁴, Lynne M Smith²⁰⁵

Affiliations

¹ AJ Drexel Autism Institute, Drexel University, Philadelphia, PA, United States.
² The Icahn School of Medicine at Mount Sinai, New York, NY, United States.
³ Rollins School of Public Health, Emory University, Atlanta, GA, United States.
⁴ Geisel School of Medicine, Dartmouth College, Hanover, NH, United States.
⁵ Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, United States.
⁶ Department of Public Health Sciences, School of Medicine, University of California Davis, Davis, CA, United States.
⁷ AJ Drexel Autism Institute, Drexel University, Philadelphia, PA, United States. Electronic address: kld98@drexel.edu.
⁸ Division of Neonatology, Department of Pediatrics, Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA.
⁹ Division of Cardiology, Department of Medicine, Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA.
¹⁰ Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
¹¹ Department of Epidemiology, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland, USA.
¹² N/A, Research Triangle Institute, Research Triangle Park, North Carolina, USA.
¹³ Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
¹⁴ Department of Pediatrics, Feinberg School of Medicine, Northwestern University and Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA.
¹⁵ Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
¹⁶ Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
¹⁷ Department of Chemistry, Vanderbilt University, Nashville, Tennessee, USA.
¹⁸ College of Engineering, Northeastern University, Boston, Massachusetts, USA.
¹⁹ College of Public Health, Department of Epidemiology & Biostatistics, University of Georgia, Athens, Georgia, USA.
²⁰ Environmental Health Sciences, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA.
²¹ Departments of Pediatrics and Population Health, NYU Grossman School of Medicine, New York, New York, USA.
²² Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
²³ Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.
²⁴ Environmental and Radiological Health Sciences, Colorado School of Public Health, Colorado State University, Fort Collins, Colorado, USA.
²⁵ Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
²⁶ Center for Health Systems Research, Denver Health and Hospital Authority, Denver, Colorado, USA.
²⁷ Department of Pediatrics, Rhode Island Hospital, The Alpert Medical School of Brown University, Providence, Rhode Island, USA.
²⁸ Division of Gender Equality, Maternal, Newborn & Child Health Discovery & Tools Team, Bill & Melinda Gates Foundation, Seattle, Washington, USA.
²⁹ Department of Statistics, University of California, Davis, Davis, California, USA.
³⁰ Division of Child and Adolescent Psychiatry, Columbia University - NYSPI, New York, New York, USA.
³¹ Department of Obstetrics & Gynecology, Columbia University - NYSPI, New York, New York, USA.
³² Behavioral Sciences Research Institute, University of Puerto Rico, School of Medicine, Rio Piedras, Puerto Rico.
³³ Child & Family Mental Health & Community Psychiatry Division, Duke University School of Medicine, Duke Psychiatry & Behavioral Sciences, Durham, North Carolina, USA.
³⁴ Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia, USA.
³⁵ Department of Psychology, Emory University, Atlanta, Georgia, USA.
³⁶ N/A, Department of Pediatrics, Avera Research Institute, University of South Dakota School of Medicine, Rapid City, South Dakota, USA; N/A, Department of Pediatrics, Avera Research Institute, University of South Dakota School of Medicine, Sioux Falls, South Dakota, USA.
³⁷ N/A, Department of Pediatrics, Avera Research Institute, University of South Dakota School of Medicine, Sioux Falls, South Dakota, USA.
³⁸ Division of Research, Kaiser Permanente Northern California, Oakland, California, USA.
³⁹ Centre for Health Informatics, University of Manchester, Manchester, United Kingdom.
⁴⁰ Department of Pediatrics, Monroe Carell Jr Children's Hospital at Vanderbilt, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
⁴¹ National Farm Medicine Center, Marshfield Clinic Research Institute, Marshfield, Wisconsin, USA.
⁴² Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.
⁴³ The Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
⁴⁴ Division of Pediatric Allergy, Immunology, and Pulmonary Medicine, Department of Medicine, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
⁴⁵ Department of Public Health Sciences, Henry Ford Health, Detroit, Michigan, USA.
⁴⁶ Department of Pediatrics, Columbia University Medical Center, New York, New York, USA.
⁴⁷ Division of Asthma Research, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
⁴⁸ Department of Medicine, University of California, San Francisco, California, USA.
⁴⁹ Department of Medicine, Division of Clinical Immunology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
⁵⁰ Department of Pediatrics, Boston University School of Medicine, Boston, Massachusetts, USA.
⁵¹ Department of Human Genetics, University of Chicago, Chicago, Illinois, USA.
⁵² Department of Pediatrics, Washington University School of Medicine, St Louis, Missouri, USA.
⁵³ Department of Pediatrics and College of Medicine, Division of Biostatistics and Epidemiology, University of Cincinnati, Cincinnati, Ohio, USA.
⁵⁴ Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
⁵⁵ Division of Allergy and Clinical Immunology, Henry Ford Health, Detroit, Michigan, USA.
⁵⁶ Department of Population and Public Health Sciences, University of Southern California, Los Angeles, California, USA.
⁵⁷ MIND Institute and Department of Public Health Sciences, University of California, Davis, Davis, California, USA.
⁵⁸ Department of Public Health Sciences, University of California, Davis, Davis, California, USA.
⁵⁹ Department of Psychiatry and Behavioral Science and the MIND Institute, University of California, Davis, Davis, California, USA.
⁶⁰ Psychiatry and Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
⁶¹ Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, Illinois, USA.
⁶² Department of Pediatrics, School of Medicine, Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, Washington, USA.
⁶³ Department of Psychiatry and Behavioral Sciences and Department of Pediatrics, School of Medicine, University of California, San Francisco, San Francisco, California, USA.
⁶⁴ Department of Psychiatry and Behavioral Sciences, School of Medicine, University of California, San Francisco, San Francisco, California, USA.
⁶⁵ Department of Pediatrics, School of Medicine, Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington and Seattle Children's Research Institute, Seattle, Washington, USA.
⁶⁶ Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA.
⁶⁷ Department of Pediatrics, Department of Environmental Medicine & Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
⁶⁸ Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, Washington, USA.
⁶⁹ Department of Counseling Psychology and Human Services & Prevention Science Institute, University of Oregon, Eugene, Oregon, USA.
⁷⁰ Department of Psychological and Behavioral Sciences, George Washington University, Washington, DC, USA.
⁷¹ Department of Psychology, Penn State University, University Park, Pennsylvania, USA.
⁷² Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.
⁷³ Pediatric Pulmonary Division, Department of Pediatrics, Golisano Children's Hospital, University of Rochester, Rochester, New York, USA.
⁷⁴ Division of Neonatology, Department of Pediatrics, Oregon Health & Science University, Portland, Oregon, USA.
⁷⁵ Division of Neuroscience, Oregon National Primate Research Center, Beaverton, Oregon, USA.
⁷⁶ Division of Pediatric Pulmonology, Department of Pediatrics, Indiana School of Medicine, Indianapolis, Indiana, USA.
⁷⁷ College of Health and Human Development, Penn State, State College, Pennsylvania, USA.
⁷⁸ AJ Drexel Autism Institute, Drexel University, Philadelphia, Pennsylvania, USA.
⁷⁹ Mental Health, Johns Hopkins University, Baltimore, Maryland, USA.
⁸⁰ Department of Psychiatry and Behavioral Sciences, Center for Autism and Related Disorders, Kennedy Krieger Institute, Johns Hopkins University, Baltimore, Maryland, USA.
⁸¹ MIND Institute, Department of Psychiatry, University of California Davis, Sacramento, California, USA.
⁸² Department of Psychiatry, University of North Carolina, Chapel Hill, North Carolina, USA.
⁸³ Center for Autism Research, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
⁸⁴ Department of Radiology, University of Washington, Seattle, Washington, USA.
⁸⁵ Department of Psychiatry, Washington University, St Louis, Missouri, USA.
⁸⁶ Department of Psychology, University of Miami, Miami, Florida, USA.
⁸⁷ Department of Psychology, University of Washington, Seattle, Washington, USA.
⁸⁸ Kaiser Permanente Division of Research, Kaiser Permanente, Oakland, California, USA.
⁸⁹ Departments of Psychiatry, Neuroscience, Obstetrics and Gynecology, University of Rochester, Rochester, New York, USA.
⁹⁰ Departments of Obstetrics and Gynecology, University of Rochester, Rochester, New York, USA.
⁹¹ Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, Massachusetts, USA.
⁹² Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
⁹³ Department of Environmental Health, Harvard Chan School of Public Health, Boston, Massachusetts, USA.
⁹⁴ Division of Neonatology, Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA.
⁹⁵ Department of Environmental Sciences and Engineering, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina, USA.
⁹⁶ EK Shriver Center and Psychiatry, UMASS Chan Medical School, Worcster, Massachusetts, USA.
⁹⁷ Department of Pediatrics, Tufts University School of Medicine, Boston, Massachusetts, USA.
⁹⁸ Department of Neurology, Harvard Medical School, Boston, Massachusetts, USA.
⁹⁹ Division of Neonatology, Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut, USA.
¹⁰⁰ Department of Pediatrics, University of Massachusetts Chan Medical School-Baystate, Springfield, Massachusetts, USA.
¹⁰¹ Department of Anatomy & Neurobiology, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA.
¹⁰² Pediatrics, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.
¹⁰³ Section of Neonatology, Department of Pediatrics, Wake Forest School of Medicine, Wake Forest University School of Medicine/Atrium Health Wake Forest, Winston-Salem, North Carolina, USA.
¹⁰⁴ Section of Neonatology, Department of Pediatrics, ECU Health, Greenville, North Carolina, USA.
¹⁰⁵ Department of Health Sciences, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
¹⁰⁶ Pediatrics, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
¹⁰⁷ Department of Anthropology, Department of Nutrition, University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Chapel Hill, North Carolina, USA.
¹⁰⁸ Epidemiology and Maternal and Child Health, University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Chapel Hill, North Carolina, USA.
¹⁰⁹ Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
¹¹⁰ Kennedy Research Center on Intellectual and Neurodevelopmental Disabilities, University of Chicago Medicine: Comer Children's Hospital, Chicago Illinois, USA.
¹¹¹ Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, Michigan, USA.
¹¹² Pediatrics, Beaumont Hospital, Royal Oak, Michigan, USA.
¹¹³ Pediatrics, Corewell Health, Helen DeVos Children's Hospital, Grand Rapids, Michigan, USA.
¹¹⁴ Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA.
¹¹⁵ Pediatrics, Mass General Hospital for Children, Boston, Massachusetts, USA.
¹¹⁶ Dean's Office Graduate School, School of Nursing and Health Studies, University of Miami, Coral Gables, Florida, USA.
¹¹⁷ Departments of Epidemiology & Biostatistics, and Pediatrics & Human Development, Michigan State University, College of Human Medicine, East Lansing, Michigan, USA.
¹¹⁸ Department of Pediatrics, Henry Ford Health, Detroit, Michigan, USA.
¹¹⁹ Department of Biostatistics, University of Michigan, Ann Arbor, Michigan, USA.
¹²⁰ Department of Obstetrics and Gynecology, Institute of Environmental Health Sciences (IEHS), C.S. Mott Center for Human Health and Development, Wayne State University, Detroit, Michigan, USA.
¹²¹ Lifecourse Epidemiology and Genomics Division, Michigan Department of Health and Human Services (MDHHS), Lansing, Michigan, USA.
¹²² Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, New York, USA.
¹²³ Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA.
¹²⁴ Beckman Institute for Advanced Science and Technology, Department of Comparative Biosciences, University of Illinois Urbana-Champaign, Urbana, Illinois, USA.
¹²⁵ Beckman Institute for Advanced Science and Technology, Department of Kinesiology and Community Health, University of Illinois Urbana-Champaign, Urbana, Illinois, USA.
¹²⁶ Beckman Institute for Advanced Science and Technology, Department of Social Work, University of Illinois Urbana-Champaign, Urbana, Illinois, USA.
¹²⁷ Department of Food Science and Human Nutrition, Michigan State University, East Lansing, Michigan, USA.
¹²⁸ Program on Reproductive Health and the Environment, University of California, San Francisco, San Francisco, California, USA.
¹²⁹ Department of Environmental Science, Policy and Management and School of Public Health, University of California, Berkeley, Berkeley, California, USA.
¹³⁰ Department of Family and Preventive Medicine, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, Utah, USA.
¹³¹ Department of Pediatrics, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, Utah, USA.
¹³² Department of Environmental Medicine & Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
¹³³ Department of Psychiatry and Behavioral Medicine, University of Washington, Seattle Children's Research Institute, Seattle, Washington, USA.
¹³⁴ Department of Population Health Sciences, University of Wisconsin, Madison, Wisconsin, USA.
¹³⁵ Department of Statistics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
¹³⁶ Department of Medicine, University of Washington, Seattle, Washington, USA.
¹³⁷ Department of Pediatrics, Albert Einstein College of Medicine, Hackensack Meridian School of Medicine, Center for Discovery and Innovation, Bronx, New York, USA, Nutley, New Jersey, USA.
¹³⁸ Department of Pediatrics, Northwell Health, Cohen Children's Medical Center, and the Zucker School of Medicine at Hofstra / Northwell, New Hyde Park, New York, USA.
¹³⁹ Department of Pediatrics, Cincinnati Children's, Cincinnati, Ohio, USA.
¹⁴⁰ Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
¹⁴¹ Department of Pediatrics, University of Rochester Medical Center, Rochester, New York, USA.
¹⁴² Department of Pediatrics, University of Florida College of Medicine, Jacksonville, Florida, USA.
¹⁴³ Department of Pediatrics, University of Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA.
¹⁴⁴ Department of Pediatrics, Children's Minnesota, Minneapolis, Minnesota, USA.
¹⁴⁵ Department of Obstetrics and Gynecology, Northwell Health and the Zucker School of Medicine at Hofstra / Northwell, New Hyde Park, New York, USA.
¹⁴⁶ Department of Science Education, Northwell Health and the Zucker School of Medicine at Hofstra / Northwell, New Hyde Park, New York, USA.
¹⁴⁷ Institute of Health System Science, Northwell Health, Feinstein Institutes for Medical Research, Manhasset, New York, USA.
¹⁴⁸ Department of Pediatrics, Children's Healthcare of Atlanta Emory University, Atlanta, Georgia, USA.
¹⁴⁹ Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
¹⁵⁰ Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
¹⁵¹ Department of Women's Health, Henry Ford Health, Detroit, Michigan, USA.
¹⁵² Department of Biostatistics and Epidemiology, Environmental and Occupational Health Sciences Institute, Rutgers University, Piscataway, New Jersey, USA.
¹⁵³ Center for Advanced Biotechnology & Medicine, Rutgers University, Piscataway, New Jersey, USA.
¹⁵⁴ Departments of Biochemistry and Microbiology & Anthropology, Rutgers University, New Brunswick, New Jersey, USA.
¹⁵⁵ Department of Pediatrics, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey, USA.
¹⁵⁶ Departments of Pediatrics, Family Medicine, and Community Health, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey, USA.
¹⁵⁷ Department of Obstetrics, Gynecology, and Reproductive Sciences, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey, USA.
¹⁵⁸ Department of Obstetrics and Gynecology, Saint Peter's University Hospital, New Brunswick, New Jersey, USA.
¹⁵⁹ Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA.
¹⁶⁰ Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, South Carolina, USA.
¹⁶¹ Department of Global and Community Health, George Mason University, Fairfax, Virginia, USA.
¹⁶² Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina, USA.
¹⁶³ Department of Biostatistics, Epidemiology and Informatics, Department of Obstetrics and Gynecology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.
¹⁶⁴ Division of Neonatology, Department of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.
¹⁶⁵ Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
¹⁶⁶ Division of Neonatology, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
¹⁶⁷ Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, Hackensack University Medical Center, Hackensack Meridian School of Medicine, Nutley, New Jersey, USA.
¹⁶⁸ Division of Neonatology, Department of Pediatrics, Hackensack University Medical Center, Hackensack Meridian School of Medicine, Nutley, New Jersey, USA.
¹⁶⁹ Division of Developmental and Behavioral Pediatrics, Department of Pediatrics, Hackensack University Medical Center, Hackensack Meridian School of Medicine, Nutley, New Jersey, USA.
¹⁷⁰ Department of Pathology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
¹⁷¹ Division of Infectious Diseases, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
¹⁷² Division of Neonatology, Department of Pediatrics, Emory University School of Medicine and Cerebral Palsy Foundation, Atlanta, Georgia, USA New York, New York, USA.
¹⁷³ Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA.
¹⁷⁴ Division of Research & Evaluation, HealthPartners Institute, Minneapolis, Minnesota, USA.
¹⁷⁵ Care Delivery Research, Allina Health, Minneapolis, Minnesota, USA.
¹⁷⁶ Department of Obstetrics and Gynecology, University of Miami Miller School of Medicine, Miami, Florida, USA.
¹⁷⁷ Department of Obstetrics, Gynecology and Reproductive Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA.
¹⁷⁸ Mailman Center for Child Development, University of Miami Miller School of Medicine, Miami, Florida, USA.
¹⁷⁹ Department of Obstetrics, Gynecology and Reproductive Sciences and Department of Public Health Sciences, University of Miami School of Medicine, Miami, Florida, USA.
¹⁸⁰ Department of Pediatrics, University of Miami Miller School of Medicine, Miami, Florida, USA.
¹⁸¹ School of Nursing and Health Studies, University of Miami, Miami, Florida, USA.
¹⁸² Psychiatry and Behavioral Sciences, MIND Institute, University of California Davis, Sacramento, California, USA.
¹⁸³ Center for Perinatal Research, Abigail Wexner Research Institute and Division of Neonatology, Nationwide Children's Hospital and Department of Pediatrics, College of Medicine and Division of Epidemiology, College of Public Health, The Ohio State University, Nationwide Children's Hospital and The Ohio State University, Columbus, Ohio, USA.
¹⁸⁴ Center for Biobehavioral Health, Abigail Wexner Research Institute, Nationwide Children's Hospital and Department of Pediatrics, College of Medicine and Division of Epidemiology, College of Public Health, The Ohio State University, Nationwide Children's Hospital and The Ohio State University, Columbus, Ohio, USA.
¹⁸⁵ Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, College of Medicine and Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, Ohio, USA.
¹⁸⁶ Center for Precision Environmental Health and Department of Medicine, Baylor College of Medicine, Houston, Texas, USA.
¹⁸⁷ Department of Family and Community Medicine, University of Texas Health Science Center at Houston (UTHealth Houston) McGovern Medical School, Houston, Texas, USA.
¹⁸⁸ Department of Obstetrics, Gynecology and Reproductive Sciences, University of Texas Health Science Center at Houston (UTHealth Houston) McGovern Medical School, Houston, Texas, USA.
¹⁸⁹ Department of Pediatrics, University of Texas Health Science Center at Houston (UTHealth Houston) McGovern Medical School, Houston, Texas, USA.
¹⁹⁰ Department of Epidemiology, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA.
¹⁹¹ Departments of Psychiatry, Pediatrics & Epidemiology, Geisel School of Medicine at Dartmouth, Dartmouth Hitchcock Medical Center, Hanover, New Hampshire, USA.
¹⁹² Community Environmental Health Program, Department of Pharmaceutical Sciences, College of Pharmacy, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA.
¹⁹³ Center for Development and Disability, University of New Mexico, Albuquerque, New Mexico, USA.
¹⁹⁴ Community Environmental Health Program, Department of Pharmaceutical Sciences UNM, College of Pharmacy, University of New Mexico Health Sciences Center, University of Chicago, Albuquerque, New Mexico, USA, Chicago, Illinois, USA.
¹⁹⁵ Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, California, USA.
¹⁹⁶ Department of Internal Medicine, Comprehensive Cancer Center, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA.
¹⁹⁷ Department of Pediatrics, Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.
¹⁹⁸ Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA.
¹⁹⁹ Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.
²⁰⁰ Department of Pediatrics, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.
²⁰¹ Department of Pediatrics, Thompson Center for Autism & Neurodevelopment, University of Missouri, Columbia, Missouri, USA.
²⁰² Department of Pediatrics, Children's Mercy-Kansas City, Kansas City, Missouri, USA.
²⁰³ Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem North Carolina, USA.
²⁰⁴ Department of Pediatrics, University of Hawaii John A Burns School of Medicine, Honolulu, Hawaii, USA.
²⁰⁵ Department of Pediatrics, UCLA Clinical and Translational Science Institute at The Lundquist Institute, Harbor-UCLA Medical Center, Los Angeles, California, USA.

PMID: 40107454
PMCID: PMC12264552
DOI: 10.1016/j.tjnut.2025.02.025

The Association of Prenatal Dietary Factors with Child Autism Diagnosis and Autism-Related Traits Using a Mixtures Approach: Results from the Environmental Influences on Child Health Outcomes Cohort

Megan G Bragg et al. J Nutr. 2025 Jun.

. 2025 Jun;155(6):1938-1951.

doi: 10.1016/j.tjnut.2025.02.025. Epub 2025 Mar 17.

Authors

Megan G Bragg¹, Juliette Rando¹, Kecia N Carroll², Stephanie M Eick³, Margaret R Karagas⁴, Pi-I Lin⁵, Rebecca J Schmidt⁶, Kristen Lyall⁷; ECHO Cohort Consortium

Collaborators

ECHO Cohort Consortium:
P Brian Smith⁸, L Kristin Newby⁹, Linda Adair¹⁰, Lisa P Jacobson¹¹, Diane Catellier¹², Monica McGrath¹¹, Christian Douglas¹², Priya Duggal¹¹, Emily Knapp¹¹, Amii Kress¹¹, Courtney K Blackwell¹³, Maxwell A Mansolf¹³, Jin-Shei Lai¹³, Emily Ho¹³, David Cella¹³, Richard Gershon¹³, Michelle L Macy¹⁴, Suman R Das¹⁵, Jane E Freedman¹⁶, Simon A Mallal¹⁵, John A McLean¹⁷, Ravi V Shah¹⁶, Meghan H Shilts¹⁵, Akram N Alshawabkeh¹⁸, Jose F Cordero¹⁹, John Meeker²⁰, Leonardo Trasande²¹, Carlos A Camargo²², Zhaozhong Zhu²², Ashley F Sullivan²², Dana Dabelea²³, Wei Perng²³, Traci A Bekelman²³, Greta Wilkening²³, Sheryl Magzamen²⁴, Brianna F Moore²³, Anne P Starling²⁵, Deborah J Rinehart²⁶, Daphne Koinis Mitchell²⁷, Viren D'Sa²⁷, Sean Cl Deoni²⁸, Hans-Georg Mueller²⁹, Cristiane S Duarte³⁰, Catherine Monk³¹, Glorisa Canino³², Jonathan Posner³³, Tenneill Murray³⁰, Claudia Lugo-Candelas³⁰, Anne L Dunlop³⁴, Patricia A Brennan³⁵, Christine Hockett³⁶, Amy Elliott³⁷, Assiamira Ferrara³⁸, Lisa A Croen³⁸, Monique M Hedderson³⁸, John Ainsworth³⁹, Leonard B Bacharier⁴⁰, Casper G Bendixsen⁴¹, James E Gern⁴², Diane R Gold⁴³, Tina V Hartert⁴⁴, Daniel J Jackson⁴², Christine C Johnson⁴⁵, Christine Lm Joseph⁴⁵, Meyer Kattan⁴⁶, Gurjit K Khurana Hershey⁴⁷, Robert F Lemanske⁴², Susan V Lynch⁴⁸, Rachel L Miller⁴⁹, George T O'Connor⁵⁰, Carole Ober⁵¹, Dennis Ownby⁴⁵, Katherine Rivera-Spoljaric⁵², Patrick H Ryan⁵³, Christine M Seroogy⁴², Anne Marie Singh⁴², Robert A Wood⁵⁴, Edward M Zoratti⁵⁵, Rima Habre⁵⁶, Shohreh Farzan⁵⁶, Frank D Gilliland⁵⁶, Irva Hertz-Picciotto⁵⁷, Deborah H Bennett⁵⁸, Julie B Schweitzer⁵⁹, Rebecca J Schmidt⁵⁷, Janine M LaSalle⁵⁸, Alison E Hipwell⁶⁰, Kate E Keenan⁶¹, Catherine J Karr⁶², Nicole R Bush⁶³, Kaja Z LeWinn⁶⁴, Sheela Sathyanarayana⁶⁵, Qi Zhao⁶⁶, Frances Tylavsky⁶⁶, Kecia N Carroll⁶⁷, Christine T Loftus⁶⁸, Leslie D Leve⁶⁹, Jody M Ganiban⁷⁰, Jenae M Neiderhiser⁷¹, Scott T Weiss⁷², Augusto A Litonjua⁷³, Cindy T McEvoy⁷⁴, Eliot R Spindel⁷⁵, Robert S Tepper⁷⁶, Craig J Newschaffer⁷⁷, Kristen Lyall⁷⁸, Heather E Volk⁷⁹, Rebecca Landa⁸⁰, Sally Ozonoff⁸¹, Joseph Piven⁸², Heather Hazlett⁸², Juhi Pandey⁸³, Robert Schultz⁸³, Steven Dager⁸⁴, Kelly Botteron⁸⁵, Daniel Messinger⁸⁶, Wendy Stone⁸⁷, Jennifer Ames⁸⁸, Thomas G O'Connor⁸⁹, Richard K Miller⁹⁰, Emily Oken⁹¹, Michele R Hacker⁹², Tamarra James-Todd⁹³, T Michael O'Shea⁹⁴, Rebecca C Fry⁹⁵, Jean A Frazier⁹⁶, Rachana Singh⁹⁷, Caitlin Rollins⁹⁸, Angela Montgomery⁹⁹, Ruben Vaidya¹⁰⁰, Robert M Joseph¹⁰¹, Lisa K Washburn¹⁰², Semsa Gogcu¹⁰³, Kelly Bear¹⁰⁴, Julie V Rollins⁹⁴, Stephen R Hooper¹⁰⁵, Genevieve Taylor¹⁰⁶, Wesley Jackson⁹⁴, Amanda Thompson¹⁰⁷, Julie Daniels¹⁰⁸, Michelle Hernandez¹⁰⁶, Kun Lu¹⁰⁹, Michael Msall¹¹⁰, Madeleine Lenski¹¹¹, Rawad Obeid¹¹², Steven L Pastyrnak¹¹³, Elizabeth Jensen¹¹⁴, Christina Sakai¹¹⁵, Hudson Santos¹¹⁶, Jean M Kerver¹¹⁷, Nigel Paneth¹¹⁷, Charles J Barone¹¹⁸, Michael R Elliott¹¹⁹, Douglas M Ruden¹²⁰, Chris Fussman¹²¹, Julie B Herbstman¹²², Amy Margolis¹²³, Susan L Schantz¹²⁴, Sarah Dee Geiger¹²⁵, Andrea Aguiar¹²⁴, Karen Tabb¹²⁶, Rita Strakovsky¹²⁷, Tracey Woodruff¹²⁸, Rachel Morello-Frosch¹²⁹, Amy Padula¹²⁸, Joseph B Stanford¹³⁰, Christina A Porucznik¹³⁰, Angelo P Giardino¹³¹, Rosalind J Wright¹³², Robert O Wright¹³², Brent Collett¹³³, Nicole Baumann-Blackmore⁴², Ronald Gangnon¹³⁴, Daniel J Jackson⁴², Chris G McKennan¹³⁵, Jo Wilson⁴², Matt Altman¹³⁶, Judy L Aschner¹³⁷, Annemarie Stroustrup¹³⁸, Stephanie L Merhar¹³⁹, Paul E Moore¹⁴⁰, Gloria S Pryhuber¹⁴¹, Mark Hudak¹⁴², Ann Marie Reynolds Lyndaker¹⁴³, Andrea L Lampland¹⁴⁴, Burton Rochelson¹⁴⁵, Sophia Jan¹³⁷, Matthew J Blitz¹⁴⁵, Michelle W Katzow¹³⁸, Zenobia Brown¹⁴⁶, Codruta Chiuzan¹⁴⁷, Timothy Rafael¹⁴⁵, Dawnette Lewis¹⁴⁵, Natalie Meirowitz¹⁴⁵, Brenda Poindexter¹⁴⁸, Tebeb Gebretsadik¹⁴⁹, Sarah Osmundson¹⁵⁰, Jennifer K Straughen⁴⁵, Amy Eapen⁵⁵, Andrea Cassidy-Bushrow⁴⁵, Ganesa Wegienka⁴⁵, Alex Sitarik⁴⁵, Kim Woodcroft⁴⁵, Audrey Urquhart⁴⁵, Albert Levin⁴⁵, Tisa Johnson-Hooper¹¹⁸, Brent Davidson¹⁵¹, Tengfei Ma⁴⁵, Emily S Barrett¹⁵², Martin J Blaser¹⁵³, Maria Gloria Dominguez-Bello¹⁵⁴, Daniel B Horton¹⁵⁵, Manuel Jimenez¹⁵⁶, Todd Rosen¹⁵⁷, Kristy Palomares¹⁵⁸, Lyndsay A Avalos³⁸, Yeyi Zhu³⁸, Kelly J Hunt¹⁵⁹, Roger B Newman¹⁶⁰, Michael S Bloom¹⁶¹, Mallory H Alkis¹⁶⁰, James R Roberts¹⁶², Sunni L Mumford¹⁶³, Heather H Burris¹⁶⁴, Sara B DeMauro¹⁶⁴, Lynn M Yee¹⁶⁵, Aaron Hamvas¹⁶⁶, Antonia F Olidipo¹⁶⁷, Andrew S Haddad¹⁶⁷, Lisa R Eiland¹⁶⁸, Nicole T Spillane¹⁶⁸, Kirin N Suri¹⁶⁹, Stephanie A Fisher¹⁶⁵, Jeffrey A Goldstein¹⁷⁰, Leena B Mithal¹⁷¹, Raye-Ann O DeRegnier¹⁶⁶, Nathalie L Maitre¹⁷², Ruby Hn Nguyen¹⁷³, Meghan M JaKa¹⁷⁴, Abbey C Sidebottom¹⁷⁵, Michael J Paidas¹⁷⁶, JoNell E Potter¹⁷⁷, Natale Ruby¹⁷⁸, Lunthita Duthely¹⁷⁹, Arumugam Jayakumar¹⁷⁷, Karen Young¹⁸⁰, Isabel Maldonado¹⁸¹, Meghan Miller¹⁸², Jonathan L Slaughter¹⁸³, Sarah A Keim¹⁸⁴, Courtney D Lynch¹⁸⁵, Kartik K Venkatesh¹⁸⁵, Kristina W Whitworth¹⁸⁶, Elaine Symanski¹⁸⁶, Thomas F Northrup¹⁸⁷, Hector Mendez-Figueroa¹⁸⁸, Ricardo A Mosquera¹⁸⁹, Margaret R Karagas¹⁹⁰, Juliette C Madan¹⁹¹, Debra M MacKenzie¹⁹², Johnnye L Lewis¹⁹², Brandon J Rennie¹⁹³, Bennett L Leventhal¹⁹⁴, Young Shin Kim¹⁹⁵, Somer Bishop¹⁹⁵, Sara S Nozadi¹⁹², Li Luo¹⁹⁶, Barry M Lester¹⁹⁷, Carmen J Marsit¹⁹⁸, Todd Everson¹⁹⁸, Cynthia M Loncar¹⁹⁹, Elisabeth C McGowan²⁰⁰, Stephen J Sheinkopf²⁰¹, Brian S Carter²⁰², Jennifer Check²⁰³, Jennifer B Helderman²⁰³, Charles R Neal²⁰⁴, Lynne M Smith²⁰⁵

Affiliations

¹ AJ Drexel Autism Institute, Drexel University, Philadelphia, PA, United States.
² The Icahn School of Medicine at Mount Sinai, New York, NY, United States.
³ Rollins School of Public Health, Emory University, Atlanta, GA, United States.
⁴ Geisel School of Medicine, Dartmouth College, Hanover, NH, United States.
⁵ Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, United States.
⁶ Department of Public Health Sciences, School of Medicine, University of California Davis, Davis, CA, United States.
⁷ AJ Drexel Autism Institute, Drexel University, Philadelphia, PA, United States. Electronic address: kld98@drexel.edu.
⁸ Division of Neonatology, Department of Pediatrics, Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA.
⁹ Division of Cardiology, Department of Medicine, Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA.
¹⁰ Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
¹¹ Department of Epidemiology, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland, USA.
¹² N/A, Research Triangle Institute, Research Triangle Park, North Carolina, USA.
¹³ Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
¹⁴ Department of Pediatrics, Feinberg School of Medicine, Northwestern University and Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA.
¹⁵ Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
¹⁶ Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
¹⁷ Department of Chemistry, Vanderbilt University, Nashville, Tennessee, USA.
¹⁸ College of Engineering, Northeastern University, Boston, Massachusetts, USA.
¹⁹ College of Public Health, Department of Epidemiology & Biostatistics, University of Georgia, Athens, Georgia, USA.
²⁰ Environmental Health Sciences, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA.
²¹ Departments of Pediatrics and Population Health, NYU Grossman School of Medicine, New York, New York, USA.
²² Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
²³ Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.
²⁴ Environmental and Radiological Health Sciences, Colorado School of Public Health, Colorado State University, Fort Collins, Colorado, USA.
²⁵ Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
²⁶ Center for Health Systems Research, Denver Health and Hospital Authority, Denver, Colorado, USA.
²⁷ Department of Pediatrics, Rhode Island Hospital, The Alpert Medical School of Brown University, Providence, Rhode Island, USA.
²⁸ Division of Gender Equality, Maternal, Newborn & Child Health Discovery & Tools Team, Bill & Melinda Gates Foundation, Seattle, Washington, USA.
²⁹ Department of Statistics, University of California, Davis, Davis, California, USA.
³⁰ Division of Child and Adolescent Psychiatry, Columbia University - NYSPI, New York, New York, USA.
³¹ Department of Obstetrics & Gynecology, Columbia University - NYSPI, New York, New York, USA.
³² Behavioral Sciences Research Institute, University of Puerto Rico, School of Medicine, Rio Piedras, Puerto Rico.
³³ Child & Family Mental Health & Community Psychiatry Division, Duke University School of Medicine, Duke Psychiatry & Behavioral Sciences, Durham, North Carolina, USA.
³⁴ Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia, USA.
³⁵ Department of Psychology, Emory University, Atlanta, Georgia, USA.
³⁶ N/A, Department of Pediatrics, Avera Research Institute, University of South Dakota School of Medicine, Rapid City, South Dakota, USA; N/A, Department of Pediatrics, Avera Research Institute, University of South Dakota School of Medicine, Sioux Falls, South Dakota, USA.
³⁷ N/A, Department of Pediatrics, Avera Research Institute, University of South Dakota School of Medicine, Sioux Falls, South Dakota, USA.
³⁸ Division of Research, Kaiser Permanente Northern California, Oakland, California, USA.
³⁹ Centre for Health Informatics, University of Manchester, Manchester, United Kingdom.
⁴⁰ Department of Pediatrics, Monroe Carell Jr Children's Hospital at Vanderbilt, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
⁴¹ National Farm Medicine Center, Marshfield Clinic Research Institute, Marshfield, Wisconsin, USA.
⁴² Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.
⁴³ The Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
⁴⁴ Division of Pediatric Allergy, Immunology, and Pulmonary Medicine, Department of Medicine, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
⁴⁵ Department of Public Health Sciences, Henry Ford Health, Detroit, Michigan, USA.
⁴⁶ Department of Pediatrics, Columbia University Medical Center, New York, New York, USA.
⁴⁷ Division of Asthma Research, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
⁴⁸ Department of Medicine, University of California, San Francisco, California, USA.
⁴⁹ Department of Medicine, Division of Clinical Immunology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
⁵⁰ Department of Pediatrics, Boston University School of Medicine, Boston, Massachusetts, USA.
⁵¹ Department of Human Genetics, University of Chicago, Chicago, Illinois, USA.
⁵² Department of Pediatrics, Washington University School of Medicine, St Louis, Missouri, USA.
⁵³ Department of Pediatrics and College of Medicine, Division of Biostatistics and Epidemiology, University of Cincinnati, Cincinnati, Ohio, USA.
⁵⁴ Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
⁵⁵ Division of Allergy and Clinical Immunology, Henry Ford Health, Detroit, Michigan, USA.
⁵⁶ Department of Population and Public Health Sciences, University of Southern California, Los Angeles, California, USA.
⁵⁷ MIND Institute and Department of Public Health Sciences, University of California, Davis, Davis, California, USA.
⁵⁸ Department of Public Health Sciences, University of California, Davis, Davis, California, USA.
⁵⁹ Department of Psychiatry and Behavioral Science and the MIND Institute, University of California, Davis, Davis, California, USA.
⁶⁰ Psychiatry and Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
⁶¹ Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, Illinois, USA.
⁶² Department of Pediatrics, School of Medicine, Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, Washington, USA.
⁶³ Department of Psychiatry and Behavioral Sciences and Department of Pediatrics, School of Medicine, University of California, San Francisco, San Francisco, California, USA.
⁶⁴ Department of Psychiatry and Behavioral Sciences, School of Medicine, University of California, San Francisco, San Francisco, California, USA.
⁶⁵ Department of Pediatrics, School of Medicine, Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington and Seattle Children's Research Institute, Seattle, Washington, USA.
⁶⁶ Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA.
⁶⁷ Department of Pediatrics, Department of Environmental Medicine & Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
⁶⁸ Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, Washington, USA.
⁶⁹ Department of Counseling Psychology and Human Services & Prevention Science Institute, University of Oregon, Eugene, Oregon, USA.
⁷⁰ Department of Psychological and Behavioral Sciences, George Washington University, Washington, DC, USA.
⁷¹ Department of Psychology, Penn State University, University Park, Pennsylvania, USA.
⁷² Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.
⁷³ Pediatric Pulmonary Division, Department of Pediatrics, Golisano Children's Hospital, University of Rochester, Rochester, New York, USA.
⁷⁴ Division of Neonatology, Department of Pediatrics, Oregon Health & Science University, Portland, Oregon, USA.
⁷⁵ Division of Neuroscience, Oregon National Primate Research Center, Beaverton, Oregon, USA.
⁷⁶ Division of Pediatric Pulmonology, Department of Pediatrics, Indiana School of Medicine, Indianapolis, Indiana, USA.
⁷⁷ College of Health and Human Development, Penn State, State College, Pennsylvania, USA.
⁷⁸ AJ Drexel Autism Institute, Drexel University, Philadelphia, Pennsylvania, USA.
⁷⁹ Mental Health, Johns Hopkins University, Baltimore, Maryland, USA.
⁸⁰ Department of Psychiatry and Behavioral Sciences, Center for Autism and Related Disorders, Kennedy Krieger Institute, Johns Hopkins University, Baltimore, Maryland, USA.
⁸¹ MIND Institute, Department of Psychiatry, University of California Davis, Sacramento, California, USA.
⁸² Department of Psychiatry, University of North Carolina, Chapel Hill, North Carolina, USA.
⁸³ Center for Autism Research, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
⁸⁴ Department of Radiology, University of Washington, Seattle, Washington, USA.
⁸⁵ Department of Psychiatry, Washington University, St Louis, Missouri, USA.
⁸⁶ Department of Psychology, University of Miami, Miami, Florida, USA.
⁸⁷ Department of Psychology, University of Washington, Seattle, Washington, USA.
⁸⁸ Kaiser Permanente Division of Research, Kaiser Permanente, Oakland, California, USA.
⁸⁹ Departments of Psychiatry, Neuroscience, Obstetrics and Gynecology, University of Rochester, Rochester, New York, USA.
⁹⁰ Departments of Obstetrics and Gynecology, University of Rochester, Rochester, New York, USA.
⁹¹ Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, Massachusetts, USA.
⁹² Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
⁹³ Department of Environmental Health, Harvard Chan School of Public Health, Boston, Massachusetts, USA.
⁹⁴ Division of Neonatology, Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA.
⁹⁵ Department of Environmental Sciences and Engineering, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina, USA.
⁹⁶ EK Shriver Center and Psychiatry, UMASS Chan Medical School, Worcster, Massachusetts, USA.
⁹⁷ Department of Pediatrics, Tufts University School of Medicine, Boston, Massachusetts, USA.
⁹⁸ Department of Neurology, Harvard Medical School, Boston, Massachusetts, USA.
⁹⁹ Division of Neonatology, Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut, USA.
¹⁰⁰ Department of Pediatrics, University of Massachusetts Chan Medical School-Baystate, Springfield, Massachusetts, USA.
¹⁰¹ Department of Anatomy & Neurobiology, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA.
¹⁰² Pediatrics, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.
¹⁰³ Section of Neonatology, Department of Pediatrics, Wake Forest School of Medicine, Wake Forest University School of Medicine/Atrium Health Wake Forest, Winston-Salem, North Carolina, USA.
¹⁰⁴ Section of Neonatology, Department of Pediatrics, ECU Health, Greenville, North Carolina, USA.
¹⁰⁵ Department of Health Sciences, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
¹⁰⁶ Pediatrics, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
¹⁰⁷ Department of Anthropology, Department of Nutrition, University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Chapel Hill, North Carolina, USA.
¹⁰⁸ Epidemiology and Maternal and Child Health, University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Chapel Hill, North Carolina, USA.
¹⁰⁹ Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
¹¹⁰ Kennedy Research Center on Intellectual and Neurodevelopmental Disabilities, University of Chicago Medicine: Comer Children's Hospital, Chicago Illinois, USA.
¹¹¹ Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, Michigan, USA.
¹¹² Pediatrics, Beaumont Hospital, Royal Oak, Michigan, USA.
¹¹³ Pediatrics, Corewell Health, Helen DeVos Children's Hospital, Grand Rapids, Michigan, USA.
¹¹⁴ Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA.
¹¹⁵ Pediatrics, Mass General Hospital for Children, Boston, Massachusetts, USA.
¹¹⁶ Dean's Office Graduate School, School of Nursing and Health Studies, University of Miami, Coral Gables, Florida, USA.
¹¹⁷ Departments of Epidemiology & Biostatistics, and Pediatrics & Human Development, Michigan State University, College of Human Medicine, East Lansing, Michigan, USA.
¹¹⁸ Department of Pediatrics, Henry Ford Health, Detroit, Michigan, USA.
¹¹⁹ Department of Biostatistics, University of Michigan, Ann Arbor, Michigan, USA.
¹²⁰ Department of Obstetrics and Gynecology, Institute of Environmental Health Sciences (IEHS), C.S. Mott Center for Human Health and Development, Wayne State University, Detroit, Michigan, USA.
¹²¹ Lifecourse Epidemiology and Genomics Division, Michigan Department of Health and Human Services (MDHHS), Lansing, Michigan, USA.
¹²² Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, New York, USA.
¹²³ Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA.
¹²⁴ Beckman Institute for Advanced Science and Technology, Department of Comparative Biosciences, University of Illinois Urbana-Champaign, Urbana, Illinois, USA.
¹²⁵ Beckman Institute for Advanced Science and Technology, Department of Kinesiology and Community Health, University of Illinois Urbana-Champaign, Urbana, Illinois, USA.
¹²⁶ Beckman Institute for Advanced Science and Technology, Department of Social Work, University of Illinois Urbana-Champaign, Urbana, Illinois, USA.
¹²⁷ Department of Food Science and Human Nutrition, Michigan State University, East Lansing, Michigan, USA.
¹²⁸ Program on Reproductive Health and the Environment, University of California, San Francisco, San Francisco, California, USA.
¹²⁹ Department of Environmental Science, Policy and Management and School of Public Health, University of California, Berkeley, Berkeley, California, USA.
¹³⁰ Department of Family and Preventive Medicine, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, Utah, USA.
¹³¹ Department of Pediatrics, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, Utah, USA.
¹³² Department of Environmental Medicine & Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
¹³³ Department of Psychiatry and Behavioral Medicine, University of Washington, Seattle Children's Research Institute, Seattle, Washington, USA.
¹³⁴ Department of Population Health Sciences, University of Wisconsin, Madison, Wisconsin, USA.
¹³⁵ Department of Statistics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
¹³⁶ Department of Medicine, University of Washington, Seattle, Washington, USA.
¹³⁷ Department of Pediatrics, Albert Einstein College of Medicine, Hackensack Meridian School of Medicine, Center for Discovery and Innovation, Bronx, New York, USA, Nutley, New Jersey, USA.
¹³⁸ Department of Pediatrics, Northwell Health, Cohen Children's Medical Center, and the Zucker School of Medicine at Hofstra / Northwell, New Hyde Park, New York, USA.
¹³⁹ Department of Pediatrics, Cincinnati Children's, Cincinnati, Ohio, USA.
¹⁴⁰ Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
¹⁴¹ Department of Pediatrics, University of Rochester Medical Center, Rochester, New York, USA.
¹⁴² Department of Pediatrics, University of Florida College of Medicine, Jacksonville, Florida, USA.
¹⁴³ Department of Pediatrics, University of Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA.
¹⁴⁴ Department of Pediatrics, Children's Minnesota, Minneapolis, Minnesota, USA.
¹⁴⁵ Department of Obstetrics and Gynecology, Northwell Health and the Zucker School of Medicine at Hofstra / Northwell, New Hyde Park, New York, USA.
¹⁴⁶ Department of Science Education, Northwell Health and the Zucker School of Medicine at Hofstra / Northwell, New Hyde Park, New York, USA.
¹⁴⁷ Institute of Health System Science, Northwell Health, Feinstein Institutes for Medical Research, Manhasset, New York, USA.
¹⁴⁸ Department of Pediatrics, Children's Healthcare of Atlanta Emory University, Atlanta, Georgia, USA.
¹⁴⁹ Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
¹⁵⁰ Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
¹⁵¹ Department of Women's Health, Henry Ford Health, Detroit, Michigan, USA.
¹⁵² Department of Biostatistics and Epidemiology, Environmental and Occupational Health Sciences Institute, Rutgers University, Piscataway, New Jersey, USA.
¹⁵³ Center for Advanced Biotechnology & Medicine, Rutgers University, Piscataway, New Jersey, USA.
¹⁵⁴ Departments of Biochemistry and Microbiology & Anthropology, Rutgers University, New Brunswick, New Jersey, USA.
¹⁵⁵ Department of Pediatrics, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey, USA.
¹⁵⁶ Departments of Pediatrics, Family Medicine, and Community Health, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey, USA.
¹⁵⁷ Department of Obstetrics, Gynecology, and Reproductive Sciences, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey, USA.
¹⁵⁸ Department of Obstetrics and Gynecology, Saint Peter's University Hospital, New Brunswick, New Jersey, USA.
¹⁵⁹ Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA.
¹⁶⁰ Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, South Carolina, USA.
¹⁶¹ Department of Global and Community Health, George Mason University, Fairfax, Virginia, USA.
¹⁶² Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina, USA.
¹⁶³ Department of Biostatistics, Epidemiology and Informatics, Department of Obstetrics and Gynecology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.
¹⁶⁴ Division of Neonatology, Department of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.
¹⁶⁵ Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
¹⁶⁶ Division of Neonatology, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
¹⁶⁷ Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, Hackensack University Medical Center, Hackensack Meridian School of Medicine, Nutley, New Jersey, USA.
¹⁶⁸ Division of Neonatology, Department of Pediatrics, Hackensack University Medical Center, Hackensack Meridian School of Medicine, Nutley, New Jersey, USA.
¹⁶⁹ Division of Developmental and Behavioral Pediatrics, Department of Pediatrics, Hackensack University Medical Center, Hackensack Meridian School of Medicine, Nutley, New Jersey, USA.
¹⁷⁰ Department of Pathology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
¹⁷¹ Division of Infectious Diseases, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
¹⁷² Division of Neonatology, Department of Pediatrics, Emory University School of Medicine and Cerebral Palsy Foundation, Atlanta, Georgia, USA New York, New York, USA.
¹⁷³ Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA.
¹⁷⁴ Division of Research & Evaluation, HealthPartners Institute, Minneapolis, Minnesota, USA.
¹⁷⁵ Care Delivery Research, Allina Health, Minneapolis, Minnesota, USA.
¹⁷⁶ Department of Obstetrics and Gynecology, University of Miami Miller School of Medicine, Miami, Florida, USA.
¹⁷⁷ Department of Obstetrics, Gynecology and Reproductive Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA.
¹⁷⁸ Mailman Center for Child Development, University of Miami Miller School of Medicine, Miami, Florida, USA.
¹⁷⁹ Department of Obstetrics, Gynecology and Reproductive Sciences and Department of Public Health Sciences, University of Miami School of Medicine, Miami, Florida, USA.
¹⁸⁰ Department of Pediatrics, University of Miami Miller School of Medicine, Miami, Florida, USA.
¹⁸¹ School of Nursing and Health Studies, University of Miami, Miami, Florida, USA.
¹⁸² Psychiatry and Behavioral Sciences, MIND Institute, University of California Davis, Sacramento, California, USA.
¹⁸³ Center for Perinatal Research, Abigail Wexner Research Institute and Division of Neonatology, Nationwide Children's Hospital and Department of Pediatrics, College of Medicine and Division of Epidemiology, College of Public Health, The Ohio State University, Nationwide Children's Hospital and The Ohio State University, Columbus, Ohio, USA.
¹⁸⁴ Center for Biobehavioral Health, Abigail Wexner Research Institute, Nationwide Children's Hospital and Department of Pediatrics, College of Medicine and Division of Epidemiology, College of Public Health, The Ohio State University, Nationwide Children's Hospital and The Ohio State University, Columbus, Ohio, USA.
¹⁸⁵ Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, College of Medicine and Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, Ohio, USA.
¹⁸⁶ Center for Precision Environmental Health and Department of Medicine, Baylor College of Medicine, Houston, Texas, USA.
¹⁸⁷ Department of Family and Community Medicine, University of Texas Health Science Center at Houston (UTHealth Houston) McGovern Medical School, Houston, Texas, USA.
¹⁸⁸ Department of Obstetrics, Gynecology and Reproductive Sciences, University of Texas Health Science Center at Houston (UTHealth Houston) McGovern Medical School, Houston, Texas, USA.
¹⁸⁹ Department of Pediatrics, University of Texas Health Science Center at Houston (UTHealth Houston) McGovern Medical School, Houston, Texas, USA.
¹⁹⁰ Department of Epidemiology, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA.
¹⁹¹ Departments of Psychiatry, Pediatrics & Epidemiology, Geisel School of Medicine at Dartmouth, Dartmouth Hitchcock Medical Center, Hanover, New Hampshire, USA.
¹⁹² Community Environmental Health Program, Department of Pharmaceutical Sciences, College of Pharmacy, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA.
¹⁹³ Center for Development and Disability, University of New Mexico, Albuquerque, New Mexico, USA.
¹⁹⁴ Community Environmental Health Program, Department of Pharmaceutical Sciences UNM, College of Pharmacy, University of New Mexico Health Sciences Center, University of Chicago, Albuquerque, New Mexico, USA, Chicago, Illinois, USA.
¹⁹⁵ Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, California, USA.
¹⁹⁶ Department of Internal Medicine, Comprehensive Cancer Center, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA.
¹⁹⁷ Department of Pediatrics, Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.
¹⁹⁸ Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA.
¹⁹⁹ Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.
²⁰⁰ Department of Pediatrics, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.
²⁰¹ Department of Pediatrics, Thompson Center for Autism & Neurodevelopment, University of Missouri, Columbia, Missouri, USA.
²⁰² Department of Pediatrics, Children's Mercy-Kansas City, Kansas City, Missouri, USA.
²⁰³ Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem North Carolina, USA.
²⁰⁴ Department of Pediatrics, University of Hawaii John A Burns School of Medicine, Honolulu, Hawaii, USA.
²⁰⁵ Department of Pediatrics, UCLA Clinical and Translational Science Institute at The Lundquist Institute, Harbor-UCLA Medical Center, Los Angeles, California, USA.

PMID: 40107454
PMCID: PMC12264552
DOI: 10.1016/j.tjnut.2025.02.025

Abstract

Background: Previous research on the role of maternal diet in relation to autism has focused on examining individual nutrient associations. Few studies have examined associations with multiple nutrients using mixtures approaches, which may better reflect true exposure scenarios.

Objectives: This study aims to examine associations of nutrient mixtures with children's autism diagnosis and trait scores within a large, diverse population.

Methods: Participants were drawn from the United States Environmental influences on Child Health Outcomes (ECHO) consortium. Maternal prenatal diet was reported via validated food frequency questionnaires. Children's autism-related traits were measured using the Social Responsiveness Scale (SRS) and autism diagnoses were from parent reports of physician diagnosis. Bayesian kernel machine regression was used to examine the overall mixture effect and interactions between a set of 5 primary nutrients (folate, vitamin D, omega 3 and omega 6 fatty acids, and iron), adjusted for potential confounders, in relationship to child outcomes. Secondary analyses were conducted in a subset of cohorts with an expanded set of 14 nutrients. Traditional linear and logistic regression models were also analyzed for comparison of results to mixture models.

Results: A total of 2614 participants drawn from 7 ECHO cohorts were included in primary analysis. Mixture analyses suggested that increasing the overall 5-nutrient mixture was associated with lower SRS scores. Individual U-shaped associations and bivariate interactions between folate and omega 3 fatty acids were suggested. In the subset included in the secondary analyses of the 14-nutrient mixture, a modest inverse trend remained, but individual nutrient associations were altered, with vitamin D demonstrating higher relative importance than other nutrients. Strong associations with autism diagnosis were not observed.

Conclusions: In this large sample, we found evidence for combined nutrient effects with broader autism-related traits. Because results for individual nutrients were sensitive to mixture components, replication of combined associations between nutrients and autism-related outcomes is needed.

Keywords: autism; epidemiology; neurodevelopment; nutrients; statistical mixtures methods.

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Conflict of interest statement

Conflict of interest The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The authors report no conflicts of interest.

Figures

**FIGURE 1**
Adjusted associations between prenatal intake of 5 nutrients and child SRS scores using hierarchical BKMR (n = 2614). Results of Bayesian kernel machine regression (BKMR) analyses in ECHO including energy-adjusted nutrient intake for omega 3 and omega 6 fatty acids, iron, vitamin D, and folate, adjusted for maternal age, maternal prepregnancy BMI, child sex (male and female), cohort type (enriched familial autism probability and general population), maternal ethnicity/race (non-Hispanic White, non-Hispanic Black, Hispanic, and other), maternal education (less than high school, high school/GED, some college/associates degree/trade school, bachelor’s degree, and graduate degree), maternal smoking (yes and no), and child year of birth (1998–2004, 2005–2009, 2010–2014, and 2015+). Plots show: (A) the overall mixture effect, or the relationship between the nutrient mixture and child SRS scores. (B) Individual nutrient associations with SRS scores, holding all other nutrients at their 50th percentile. (C) Single-exposure effects; plot shows the impact on a child SRS score when each exposure increases from its 25th to 75th percentile (whereas other exposures are fixed at their 25th, 50th, or 75th percentiles). (D) Interaction parameters; plot compares the single-exposure health risk of each exposure (associated with a change from its 25th to 75th percentile) when other exposures are fixed to their 75th percentile compared with their 25th percentile. The primary set of nutrients included here was selected as described in the text based on a priori interest for neurodevelopmental relevance and grouped by shared pathway. ECHO, Environmental influences on Child Health Outcomes; SRS, Social Responsiveness Scale.

**FIGURE 2**
Adjusted bivariate associations between prenatal intake of 5 nutrients and child SRS scores using hierarchical Bayesian kernel machine regression (BKMR) (n = 2614). Results of BKMR analyses in ECHO including energy-adjusted nutrient intake for omega 3 and omega 6 fatty acids, iron, vitamin D, and folate, adjusted for maternal age, maternal prepregnancy BMI, child sex (male and female), cohort type (enriched familial autism probability and general population), maternal ethnicity/race (non-Hispanic White, non-Hispanic Black, Hispanic, and other), maternal education (less than high school, high school/GED, some college/associates degree/trade school, bachelor’s degree, and graduate degree), maternal smoking (yes and no), and child year of birth (1998–2004, 2005–2009, 2010–2014, and 2015+). Plots show bivariate exposure–response function for 2 predictors, where the second predictor is fixed at various percentiles (10th, 50th, and 90th), and all other predictors are fixed at the 50th percentile. The magnified plot shows the association of folate with SRS score at different quantiles of omega 3 fatty acids. Intersecting lines suggest an interaction between folate and omega 3 fatty acids. ECHO, Environmental influences on Child Health Outcomes; SRS, Social Responsiveness Scale.

**FIGURE 3**
Adjusted associations between prenatal intake of 14 nutrients and child SRS scores using hierarchical Bayesian kernel machine regression (BKMR) (n = 952). Results of BKMR analyses in ECHO including energy-adjusted nutrient intake for omega 3 and omega 6 fatty acids, iron, vitamin D, folate, zinc, vitamin B₁₂, vitamin B₆, choline, betaine, vitamin A, vitamin C, vitamin E, and methionine, adjusted for maternal age, maternal prepregnancy BMI, child sex (male, female), cohort type (enriched familial autism probability, general population), maternal ethnicity/race (non-Hispanic White, non-Hispanic Black, Hispanic, and other), maternal education (less than high school, high school/GED, some college/associates degree/trade school, bachelor’s degree, and graduate degree), maternal smoking (yes, no), and child year of birth (1998–2004, 2005–2009, 2010–2014, and 2015+). Plots show: (A) the overall mixture effect, or the relationship between the nutrient mixture and child SRS scores. (B) Individual nutrient associations with SRS scores, holding all other nutrients at their 50th percentile. (C) Single-exposure effects; plot shows the impact on child SRS score when each exposure increases from its 25th to 75th percentile (whereas other exposures are fixed at their 25th, 50th, or 75th percentiles). (D) Interaction parameters; plot compares the single-exposure health risk of each exposure (associated with a change from its 25th to 75th percentile) when other exposures are fixed to their 75th percentile compared with their 25th percentile. The set of nutrients included here was selected as described in the text based on a priori interest for neurodevelopmental relevance and grouped by shared pathway. ECHO, Environmental influences on Child Health Outcomes; SRS, Social Responsiveness Scale.

**FIGURE 4**
Adjusted bivariate associations between prenatal intake of 14 nutrients and child SRS scores using hierarchical Bayesian kernel machine regression (BKMR) (n = 952). Results of BKMR analyses in ECHO including energy-adjusted nutrient intake for omega 3 and omega 6 fatty acids, iron, vitamin D, folate, zinc, vitamin B₁₂, vitamin B₆, choline, betaine, vitamin A, vitamin C, vitamin E, and methionine, adjusted for maternal age, maternal prepregnancy BMI, child sex (male, female), cohort type (enriched familial autism probability, and general population), maternal ethnicity/race (non-Hispanic White, non-Hispanic Black, Hispanic, and other), maternal education (less than high school, high school/GED, some college/associates degree/trade school, bachelor’s degree, and graduate degree), maternal smoking (yes and no), and child year of birth (1998–2004, 2005–2009, 2010–2014 and 2015+). Plots show bivariate exposure–response function for 2 predictors, where the second predictor is fixed at various percentiles (10th, 50th, and 90th) and all other predictors are fixed at the 50th percentile. The set of nutrients included here was selected as described in the text based on a priori interest for neurodevelopmental relevance and grouped by shared pathway. ECHO, Environmental influences on Child Health Outcomes.

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References

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The Association of Prenatal Dietary Factors with Child Autism Diagnosis and Autism-Related Traits Using a Mixtures Approach: Results from the Environmental Influences on Child Health Outcomes Cohort

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The Association of Prenatal Dietary Factors with Child Autism Diagnosis and Autism-Related Traits Using a Mixtures Approach: Results from the Environmental Influences on Child Health Outcomes Cohort

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