Sex-specific associations between maternal prenatal and postnatal psychological distress and autism spectrum disorder in the Japan Environment and Children’s Study

Maternal prenatal and postnatal psychological distress, including depression and anxiety are risk factors for the development of autism spectrum disorder (ASD) in children. However, there is inconsistent knowledge regarding the period in pregnancy during which psychological distress may influence this risk, and the associated sex-specific differences. We evaluated the association between the six-item Kessler Psychological Distress Scale (K6) for mothers and ASD in 6-year-old children, using the Japan Environment and Children's Study dataset. In total, 32,417 boys and 30,996 girls were included in the analysis. The K6 was administered during the first half of pregnancy (medians of 15 weeks); the second half of pregnancy (medians of 27 weeks); and at 1 year postpartum, and multivariate logistic regression analyses were performed on the group with a K6 score ≤ 4 as reference. In boys, maternal psychological distress in the first half of pregnancy and at 1 year postpartum were associated with ASD. In girls, maternal psychological distress coexisting during pregnancy and at 1 year postpartum was associated with ASD.