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.

1 Follower
29 Reads
    • "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. "
    [Show abstract] [Hide abstract]
    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
  • Source
    • "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]. "
    [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
    [Show abstract] [Hide abstract]
    ABSTRACT: Late preterm birth confers increased risk of developmental delay, academic difficulties and social deficits. The late third trimester may represent a critical period of development of neural networks including the default mode network (DMN), which is essential to normal cognition. Our objective is to identify functional and structural connectivity differences in the posteromedial cortex related to late preterm birth. Thirty-eight preadolescents (ages 9-13; 19 born in the late preterm period (≥32 weeks gestational age) and 19 at term) without access to advanced neonatal care were recruited from a low socioeconomic status community in Brazil. Participants underwent neurocognitive testing, 3-dimensional T1-weighted imaging, diffusion-weighted imaging and resting state functional MRI (RS-fMRI). Seed-based probabilistic diffusion tractography and RS-fMRI analyses were performed using unilateral seeds within the posterior DMN (posterior cingulate cortex, precuneus) and lateral parietal DMN (superior marginal and angular gyri). Late preterm children demonstrated increased functional connectivity within the posterior default mode networks and increased anti-correlation with the central-executive network when seeded from the posteromedial cortex (PMC). Key differences were demonstrated between PMC components with increased anti-correlation with the salience network seen only with posterior cingulate cortex seeding but not with precuneus seeding. Probabilistic tractography showed increased streamlines within the right inferior longitudinal fasciculus and inferior fronto-occipital fasciculus within late preterm children while decreased intrahemispheric streamlines were also observed. No significant differences in neurocognitive testing were demonstrated between groups. Late preterm preadolescence is associated with altered functional connectivity from the PMC and lateral parietal cortex to known distributed functional cortical networks despite no significant executive neurocognitive differences. Selective increased structural connectivity was observed in the setting of decreased posterior interhemispheric connections. Future work is needed to determine if these findings represent a compensatory adaptation employing alternate neural circuitry or could reflect subtle pathology resulting in emotional processing deficits not seen with neurocognitive testing.
    PLoS ONE 06/2015; 10(6):e0130686. DOI:10.1371/journal.pone.0130686 · 3.23 Impact Factor
Show more