Environment/Climate Change
Prenatal and postnatal exposure to ambient temperature and risk of ASD/ADHD among Medicaid recipients Stefania Papatheodorou* Stefania Papatheodorou Papatheodorou Papatheodorou Papatheodorou Papatheodorou Papatheodorou Papatheodorou Papatheodorou Papatheodorou Papatheodorou Papatheodorou Papatheodorou Rutgers School of Public Health
Abstract
Background:
Epidemiologic evidence linking ambient temperature exposure to the risk of autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) remains limited, particularly among low-income populations who may be disproportionately vulnerable to environmental stressors.
Methods:
We constructed a population-based mother–child cohort using the Medicaid Analytic eXtract (MAX) from 2001–2014. ASD and ADHD diagnoses were identified using ICD-9/10 codes. Ambient temperature was assigned at the ZIP-code level at the last menstrual period and at birth. Cox proportional hazards models were used to estimate associations between average prenatal and postnatal temperature exposure and risk of ASD and ADHD. Distributed lag non-linear models characterized exposure windows across pregnancy (0–37 weeks) and early childhood (0–3 years). Models adjusted for maternal and child demographics, behavioral risk factors, ambient PM₂.₅, season of conception, and area-level socioeconomic status. Effect modification by child sex was evaluated.
Results:
Among 1,548,303 births, a 1 °C increase in average prenatal temperature was associated with a modestly higher risk of ASD (hazard ratio [HR] = 1.02; 95% CI: 1.00–1.03) and a lower risk of ADHD (HR = 0.96; 95% CI: 0.95–1.00) over the cumulative prenatal lag. Postnatal exposure to heatwaves was associated with increased risk of ASD (HR = 1.08; 95% CI: 1.02–1.15) and ADHD (HR = 1.02; 95% CI: 1.00–1.10) across early childhood. No evidence of effect modification by child sex was observed.
Conclusions:
Prenatal and early-life temperature exposures were associated with increased risk of ASD among low-income children in the United States, underscoring the potential neurodevelopmental implications of weather-related exposures in socioeconomically vulnerable populations.