Prevalence and Neonatal Factors Associated with Autism Spectrum Disorders in Preterm Infants

Division of Neonatology, Department of Pediatrics, University of California-San Francisco, San Francisco, CA.
The Journal of pediatrics (Impact Factor: 3.79). 10/2013; 164(1). DOI: 10.1016/j.jpeds.2013.09.021
Source: PubMed


To determine the prevalence of autism spectrum disorders (ASD) across gestational age, examine the risk of ASD by gestational age controlling for other risk factors, and identify potential risk factors in the neonatal intensive care unit.
A retrospective cohort of infants born at ≥24 weeks between January 1, 2000, and December 31, 2007 at 11 Kaiser Permanente Northern California hospitals (n = 195 021). ASD cases were defined by a diagnosis made at a Kaiser Permanente ASD evaluation center, by a clinical specialist, or by a pediatrician. Cox proportional hazards regression models were used to evaluate the association between gestational age and ASD as well as potential risk factors in the neonatal intensive care unit and ASD.
The prevalence of ASD in infants <37 weeks was 1.78% compared with 1.22% in infants born ≥37 weeks (P < .001). Compared with term infants, infants born at 24-26 weeks had an adjusted hazard ratio (HR) for a diagnosis of ASD of 2.7 (95% CI 1.5-5.0). Infants born at 27-33 weeks (adjusted HR 1.4, 95% CI 1.1-1.8) and 34-36 weeks (adjusted HR 1.3, 95% CI 1.1-1.4) were also at increased risk. High frequency ventilation and intracranial hemorrhage were associated with ASD in infants < 34 weeks.
ASD was ∼3 times more prevalent in infants <27 weeks compared with term infants. Each week of shorter gestation was associated with an increased risk of ASD. High frequency ventilation and intracranial hemorrhage were associated with ASD among infants <34 weeks.

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    • "Autism Spectrum Disorder (ASD) is characterized by persistent deficits in social interaction and communication as well as restrictive, repetitive patterns of behavior, interests or activities [American Psychiatric Association, 2013]. Survivors of very preterm (VP) birth (born <32 weeks' gestational age) are at increased risk of autism spectrum symptoms and disorder compared with termborn peers [Johnson et al., 2010; Kuzniewicz et al., 2014; Treyvaud et al., 2013]. Timely identification of ASD is critical because early intervention has been shown to be effective in decreasing impairments, and may result in more positive long-term outcomes [Bryson , Rogers, & Fombonne, 2003; Filipek et al., 1999]. "
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    ABSTRACT: Very preterm (VP) survivors are at increased risk of autism spectrum disorder (ASD) compared with term-born children. This study explored whether neonatal magnetic resonance (MR) brain features differed in VP children with and without ASD at 7 years. One hundred and seventy-two VP children (<30 weeks' gestation or <1250 g birth weight) underwent structural brain MR scans at term equivalent age (TEA; 40 weeks' gestation ±2 weeks) and were assessed for ASD at 7 years of age. The presence and severity of white matter, cortical gray matter, deep nuclear gray matter, and cerebellar abnormalities were assessed, and total and regional brain volumes were measured. ASD was diagnosed using a standardized parent report diagnostic interview and confirmed via an independent assessment. Eight VP children (4.7%) were diagnosed with ASD. Children with ASD had more cystic lesions in the cortical white matter at TEA compared with those without ASD (odds ratio [OR] 8.7, 95% confidence interval [CI] 1.5, 51.3, P = 0.02). There was also some evidence for smaller cerebellar volumes in children with ASD compared with those without ASD (OR = 0.82, CI = 0.66, 1.00, P = 0.06). Overall, the results suggest that VP children with ASD have different brain structure in the neonatal period compared with those who do not have ASD. Autism Res 2015. © 2015 International Society for Autism Research, Wiley Periodicals, Inc.
    Autism Research 10/2015; DOI:10.1002/aur.1558 · 4.33 Impact Factor
    • "Leavey, Zwaigenbaum, Heavner, and Burstyn studied children born 1998 to 2004 in Canada and observed around a 2.5-fold increased risk of ASD if born in GA week 29 but a risk below two-fold if born in GA week 32 or later, compared with children born at term [Leavey et al., 2013]. Kuzniewicz et al. studied children born 2000 to 2007 in California and found that ASD was around three times more prevalent in infants born before GA 27 weeks compared with term infants but a risk below two-fold if born in GA week 27 or later, compared to children born at term [Kuzniewicz et al., 2014]. The variation in risk estimates for ASD by GA among the aforementioned studies may reflect, in part, time trends in the association between ASD and GA. "
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    ABSTRACT: Autism Spectrum Disorder (ASD) is a serious neurodevelopmental disorder. Several previous studies have identified preterm birth as a risk factor for ASD but none has studied whether the association between gestational age and ASD has changed over time. This is a Danish population-based follow-up study including live-born singletons born in Denmark between 1980 and 2009, identified in the Danish Medical Birth Registry, a study population of 1,775,397 children. We used a Cox regression model combined with spline to study the risk for ASD by gestational age across three decades of birth cohorts. We included 19,020 children diagnosed with ASD. Across all birth year cohorts, we found that the risk of being diagnosed with ASD increased with lower gestational age (P-value: <0.01). Across all gestational weeks, we found a statistically significant higher risk estimates in birth cohort 1980 to 1989, compared to birth cohorts 1990 to 1999 and 2000 to 2009, respectively. No statistically significant difference in risk estimates was observed between birth cohort 1990 to 1999 and 2000 to 2009. The observed time trend in risk of ASD after preterm birth may reflect: (1) a change in the risk profile of persons with ASD due to the broadening of ASD diagnostic criteria over time; or (2) improved neonatal care for low GA infants, which has reduced risk of adverse outcomes like ASD in preterm children. Autism Res 2015. © 2015 International Society for Autism Research, Wiley Periodicals, Inc.
    Autism Research 09/2015; DOI:10.1002/aur.1525 · 4.33 Impact Factor
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    • "These include the type of birth, such as whether it was breech, a prolonged birth, or an induced birth, along with various forms of fetal measures such as birth cry, fetal distress, low heart rate, or high fetal blood pressure [2, 3, 13–15, 60]. Further, a possible association exists with ventilation of neonates [16]. Feeding practices have also been looked at, as well as maternal states such as high temperature or an unhappy maternal emotional state [17–19, 58]. "
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    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
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