Does gestational weight gain increase the risk of autism spectrum disorder in offspring? Evidence from a large-scale cumulative meta-analysis with stability thresholds
1
Centre for Public Health, Equity and Human Flourishing, Torrens University Australia, Adelaide, Australia
Popul. Med. 2026;8(Supplement Supplement 1):A2076
ABSTRACT
INTRODUCTION:
Whether excessive or inadequate gestational weight gain (GWG) contributes to the risk of autism spectrum disorder (ASD) in offspring remains uncertain, with existing studies reporting inconsistent and often inconclusive findings. To address this unresolved question, we conducted large-scale cumulative meta-analyses to quantify the strength and direction of these associations and to identify the point at which the evidence became sufficiently consistent to inform clinical practice.
METHODS:
We followed PRISMA guidelines, searching major databases (PubMed, PsycINFO, Scopus and Embase) for all studies up to September 2025 with no restrictions. Methodological quality of the included studies was appraised using the revised Newcastle Ottawa Scale. Cumulative meta-analyses were undertaken using inverse variance-weighted random effects models to pool adjusted relative risks (RR) with corresponding 95% confidence intervals (CIs), newly published articles added sequentially. We estimated the RRs and their 95% CI limits that a new study would require to shift the cumulative RR toward the null, using a stability threshold analysis. The statistical power of the meta-analysis was checked using a power curve based on the observed heterogeneity.
RESULTS:
Eighteen observational studies published from 2010 to 2025, including 651,859 mother–child pairs, were included in the cumulative meta-analyses. Excessive GWG was associated with a higher risk of ASD (RR=1.32, 95% CI:1.11-1.56). The final stability threshold was 0.74, meaning that a new observational would need to report a 26% risk reduction to change this conclusion. However, there was insufficient evidence of an association between inadequate GWG and ASD risk (RR = 1.03, 95% CI: 0.91–1.17).
CONCLUSIONS:
Our study demonstrated that excessive, but not inadequate, GWG was associated with a higher risk of ASD in offspring. Based on current evidence, future studies are unlikely to change this conclusion. Promoting healthy GWG may be a cost-effective approach to minimise ASD in offspring.
Whether excessive or inadequate gestational weight gain (GWG) contributes to the risk of autism spectrum disorder (ASD) in offspring remains uncertain, with existing studies reporting inconsistent and often inconclusive findings. To address this unresolved question, we conducted large-scale cumulative meta-analyses to quantify the strength and direction of these associations and to identify the point at which the evidence became sufficiently consistent to inform clinical practice.
METHODS:
We followed PRISMA guidelines, searching major databases (PubMed, PsycINFO, Scopus and Embase) for all studies up to September 2025 with no restrictions. Methodological quality of the included studies was appraised using the revised Newcastle Ottawa Scale. Cumulative meta-analyses were undertaken using inverse variance-weighted random effects models to pool adjusted relative risks (RR) with corresponding 95% confidence intervals (CIs), newly published articles added sequentially. We estimated the RRs and their 95% CI limits that a new study would require to shift the cumulative RR toward the null, using a stability threshold analysis. The statistical power of the meta-analysis was checked using a power curve based on the observed heterogeneity.
RESULTS:
Eighteen observational studies published from 2010 to 2025, including 651,859 mother–child pairs, were included in the cumulative meta-analyses. Excessive GWG was associated with a higher risk of ASD (RR=1.32, 95% CI:1.11-1.56). The final stability threshold was 0.74, meaning that a new observational would need to report a 26% risk reduction to change this conclusion. However, there was insufficient evidence of an association between inadequate GWG and ASD risk (RR = 1.03, 95% CI: 0.91–1.17).
CONCLUSIONS:
Our study demonstrated that excessive, but not inadequate, GWG was associated with a higher risk of ASD in offspring. Based on current evidence, future studies are unlikely to change this conclusion. Promoting healthy GWG may be a cost-effective approach to minimise ASD in offspring.
| eISSN: | 2654-1459 |
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