Prenatal, Perinatal, and Neonatal Factors Associated With Autism Spectrum Disorders

Division of Child and Adolescent Psychiatry, Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, Utah, USA.
PEDIATRICS (Impact Factor: 5.3). 06/2009; 123(5):1293-300. DOI: 10.1542/peds.2008-0927
Source: PubMed

ABSTRACT To investigate prenatal, perinatal, and neonatal risk factors for autism spectrum disorders by using participants identified through broad ascertainment and reliable classification methods.
The targeted population was 8-year-old children born in 1994 and residing in 1 of the 3 most populous counties in Utah who were identified as having an autism spectrum disorder on the basis of methodology used by the 2002 Autism and Developmental Disabilities Monitoring Network. Of those identified, 132 children (115 boys, 17 girls) had birth certificate records available. Each child was matched by gender and birth year to 100 controls (11 500 boys, 1700 girls) from the birth certificate database in a nested case-control design. Birth certificate records of participants and controls were surveyed for 23 potentially pathologic prenatal, perinatal, and neonatal factors.
The prenatal factors that occurred significantly more frequently among children with autism spectrum disorders were advanced maternal age and parity. Increased duration of education among mothers of children with autism spectrum disorders was small but statistically significant. Significant perinatal factors were breech presentation and primary cesarean delivery. When corrected for breech presentation, a known indication for cesarean delivery, the association between primary cesarean delivery and autism spectrum disorders was eliminated. There were no significant associations found between autism spectrum disorders and neonatal factors.
In the absence of other complications suggesting fetal distress, the association between breech presentation and autism spectrum disorders in this study suggests a shared etiology rather than causal relationship. Additional investigation focused on both genetic and environmental factors that link these autism spectrum disorder risk factors individually or collectively is needed.

Download full-text


Available from: Deborah Bilder, Jul 14, 2015
  • Source
    • "Mode of delivery confounders : The four studies that adjusted for assisted or operational vaginal delivery ( Bilder et al . , 2009 ; Gregory et al . , 2013 ; Langridge et al . , 2013 ; Polo - Kantola et al . , 2014 ) produced a pooled OR of 1 . 14 ( 95% CI : 0 . 97 , 1 . 33 ; Table 1 ) . The three studies that adjusted for induc - tion of labour in their model ( Burstyn et al . , 2010 ; Gregory et al . , 2013 ; Polo - Kantola et al . , 2014 ) had a pooled OR of 1 ."
    [Show abstract] [Hide abstract]
    ABSTRACT: Background Given the growing prevalence of birth by Caesarean section (CS) worldwide, it is important to understand any long-term effects CS delivery may have on a child's development. We assessed the impact of mode of delivery on autism spectrum disorders (ASD) and attention-deficit/hyperactivity disorder (ADHD).Methods We conducted a systematic review of the literature in PubMed, Embase, CINAHL, PsycINFO and Web of Science up to 28 February 2014. No publication date, language, location or age restrictions were employed.ResultsThirteen studies reported an adjusted estimate for CS-ASD, producing a pooled odds ratio (OR) of 1.23 (95% CI: 1.07, 1.40). Two studies reported an adjusted estimate for CS-ADHD, producing a pooled OR of 1.07 (95% CI: 0.86, 1.33).Conclusions Delivery by CS is associated with a modest increased odds of ASD, and possibly ADHD, when compared to vaginal delivery. Although the effect may be due to residual confounding, the current and accelerating rate of CS implies that even a small increase in the odds of disorders, such as ASD or ADHD, may have a large impact on the society as a whole. This warrants further investigation.
    Journal of Child Psychology and Psychiatry 10/2014; 56(5). DOI:10.1111/jcpp.12351 · 5.67 Impact Factor
  • Source
    • "supported the existence of the links between autism and factors that relate to pre-, peri-, and neonatal care. Such commonly identified, prenatal risk factors may include advancedaged parents, a short gestation period, low birth weight, hyperbilirubinemia, and breech presentation [3]. Another key factor may be the use of any prenatal, prescription medication [4] [5] [6]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Autism is a neurodevelopmental disorder marked by severe deficits in social communication and interactions. It is a complex condition that lacks an established preventive method, warranting a need for research to identify possible environmental triggers. The identification of external factors particularly perinatal risk factors forms the initial critical step in preventing and alleviating risks. We conducted a literature review to assess evidence suggested in the worldwide literature. Perinatal risk factors that have a suggested association include íµí»½2 adrenergic receptor agonists, labor induction and augmentation, maternal infection and disease (i.e., antiphospholipid syndrome), antiepileptic drugs, cocaine use, and oral supplements. Smoking has not been found to have a direct association. Pollutants, selective serotonin reuptake inhibitors, artificial insemination, and fertility medications may have a link, but results are often conflicted. Factors related to the delivery room experience may be associated with meconium aspiration syndrome, birth weight, and labor time. Several risk factors during the pregnancy and labor periods have been associated with autism; yet further studies with large populations are needed to establish definitive associations. The fact that several risk factors during the prenatal and labor periods are implicated in autism should prompt the medical community to focus on the pregnancy and labor periods as preventive measures to curb the incidence of autism.
    International Scholarly Research Notices 10/2014; 2014(Article ID 290837). DOI:10.1155/2014/290837
  • Source
    • "This is in agreement with El-Baz et al. [23] who reported that the rate of consanguinity is lower among parents of patients with autism than in normal controls which means that consanguinity has no role in autism. Similar findings were reported by many authors [24] [25] [26]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Classical autism belongs to a group of heterogeneous neurobehavioral disorders known as autism spectrum disorders (ASDs) characterized by abnormalities in social interaction, impaired communication, and repetitive stereotypic behaviors. Overall, there is an increased risk of ASDs associated with common mutations affecting the folate/methylation cycle. This study aimed at identification of the C677T polymorphic genotypes of MTHFR gene among the Egyptian children with autism and to correlate them with different phenotypes.
    Egyptian Journal of Medical Human Genetics 06/2014; 15(4). DOI:10.1016/j.ejmhg.2014.05.004
Show more