Journal Articles

Association of Autism With Induced or Augmented Childbirth in North Carolina Birth Record (1990-1998) and Education Research (1997-2007) Databases.

August 12, 2013

Association of Autism With Induced or Augmented Childbirth in North Carolina Birth Record (1990-1998) and Education Research (1997-2007) Databases. JAMA Pediatrics, August 12, 2013. Simon G. Gregory, PhD; Rebecca Anthopolos, MA; Claire E. Osgood, BS; Chad A. Grotegut, MD; Marie Lynn Miranda, PhD.

Center for Human Genetics, Department of Medicine, Duke University Medical Center, Durham, NC: Duke Institute of Molecular Physiology, Duke University Medical Center, Durham, NC; Children’s Environmental Health Initiative, School of Natural Resources and Environment, University of Michigan, Ann Arbor; Children’s Environmental Health Initiative, Duke University, Durham, NC; Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC: Children’s Environmental Health Initiative, School of Natural Resources and Environment and Department of Pediatrics, University of Michigan, Ann Arbor.

Importance      One in 88 children in the United States is diagnosed as having autism spectrum disorder. Significant interest centers on understanding the environmental factors that may contribute to autism risk.

Objective      To examine whether induced (stimulating uterine contractions prior to the onset of spontaneous labor) and/or augmented (increasing the strength, duration, or frequency of uterine contractions with spontaneous onset of labor) births are associated with increased odds of autism.

Design, Setting, and Participants      We performed an epidemiological analysis using multivariable logistic regression modeling involving the North Carolina Detailed Birth Record and Education Research databases. The study featured 625 042 live births linked with school records, including more than 5500 children with a documented exceptionality designation for autism.

Exposures      Induced or augmented births.

Main Outcomes and Measures      Autism as assessed by exceptionality designations in child educational records.

Results      Compared with children born to mothers who received neither labor induction nor augmentation, children born to mothers who were induced and augmented, induced only, or augmented only experienced increased odds of autism after controlling for potential confounders related to socioeconomic status, maternal health, pregnancy-related events and conditions, and birth year. The observed associations between labor induction/augmentation were particularly pronounced in male children.

Conclusions and Relevance      Our work suggests that induction/augmentation during childbirth is associated with increased odds of autism diagnosis in childhood. While these results are interesting, further investigation is needed to differentiate among potential explanations of the association including underlying pregnancy conditions requiring the eventual need to induce/augment, the events of labor and delivery associated with induction/augmentation, and the specific treatments and dosing used to induce/augment labor (eg, exogenous oxytocin and prostaglandins).

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