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: 5.47). 06/2009; 123(5):1293-300. DOI: 10.1542/peds.2008-0927
Source: PubMed


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.

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Available from: Deborah Bilder
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    • "The study is population-based and the linkage rates for the various population-based datasets were high. Data were available for a number of important socio-demographic confounding factors as well as for perinatal outcomes found previously to be associated with both ART and autism in US populations (Schieve et al. 2007; Croen et al. 2002b; Durkin et al. 2008; Durkin et al. 2010; Bilder et al. 2009; Mandell et al. 2009; Schieve et al. 2012a). Thus, we were able to thoroughly explore the underlying reasons for the initial differences observed between ART-and non-ART-conceived children. "
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    ABSTRACT: Previous studies report associations between conception with assisted reproductive technology (ART) and autism. Whether these associations reflect an ascertainment or biologic effect is undetermined. We assessed diagnosis age and initial autism symptom severity among >30,000 children with autism from a linkage study of California Department of Developmental Services records, birth records, and the National ART Surveillance System. Median diagnosis age and symptom severity levels were significantly lower for ART-conceived than non-ART-conceived children. After adjustment for differences in the socio-demographic profiles of the two groups, the diagnosis age differentials were greatly attenuated and there were no differences in autism symptomatology. Thus, ascertainment issues related to SES, not ART per se, are likely the driving influence of the differences we initially observed.
    Full-text · Article · May 2015 · Journal of Autism and Developmental Disorders
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    • "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 ."
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    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.
    Full-text · Article · Oct 2014 · Journal of Child Psychology and Psychiatry
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    • "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]. "
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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.
    Full-text · Article · Oct 2014 · International Scholarly Research Notices
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