Maternal Serotonin Levels Are Associated With Cognitive Ability and Core Symptoms in Autism Spectrum Disorder

Alicia K. Montgomery, Lauren C. Shuffrey, Stephen J. Guter, George M. Anderson, Suma Jacob, Matthew W. Mosconi, John A Sweeney, J. Blake Turner, James S. Sutcliffe, Edwin H. Cook, Jeremy Veenstra-VanderWeele

Research output: Contribution to journalArticlepeer-review

18 Scopus citations


Objective: The serotonin (5-hydroxytryptamine [HT]) system has long been implicated in autism spectrum disorder (ASD). Whole-blood 5-HT level (WB5-HT) is a stable, heritable biomarker that is elevated in more than 25% of children with ASD. Recent findings indicate that the maternal 5-HT system may influence embryonic neurodevelopment, but maternal WB5-HT has not been examined in relation to ASD phenotypes. Method: WB5-HT levels were obtained from 181 individuals (3–27 years of age) diagnosed with ASD, 99 of their fathers, and 119 of their mothers. Standardized assessments were used to evaluate cognitive, behavioral, and language phenotypes. Results: Exploratory regression analyses found relationships between maternal WB5-HT and nonverbal IQ (NVIQ), Autism Diagnostic Interview-Revised (ADI-R) Nonverbal Communication Algorithm scores, and overall adaptive function on the Vineland Adaptive Behavior Scales−II. Latent class analysis identified a three-class structure in the assessment data, describing children with low, intermediate, and high severity across measures of behavior, cognition, and adaptive function. Mean maternal WB5-HT differed across classes, with the lowest maternal WB5-HT levels seen in the highest-severity group (Welch F2,46.048 = 17.394, p <.001). Paternal and proband WB5-HT did not differ between classes. Conclusion: Maternal WB5-HT is associated with neurodevelopmental outcomes in offspring with ASD. Prospective, longitudinal studies will be needed to better understand the relationship between the function of the maternal serotonin system during pregnancy and brain development. Further studies in animal models may be able to reveal the mechanisms underlying these findings.

Original languageEnglish (US)
Pages (from-to)867-875
Number of pages9
JournalJournal of the American Academy of Child and Adolescent Psychiatry
Issue number11
StatePublished - Nov 2018


  • 5-HT
  • autism spectrum disorder
  • hyperserotonemia
  • maternal
  • serotonin

ASJC Scopus subject areas

  • Developmental and Educational Psychology
  • Psychiatry and Mental health


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