Induced and augmented labor associated with autism
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1. Mothers who underwent labor induction and/or augmentation were more likely to have a child with autism.
2. Among children delivered after labor induction and/or augmentation, males were more likely to be diagnosed with autism than females.
Evidence Rating Level: 2 (Good)
Study Rundown: This study found that labor induction and/or augmentation was associated with increased odds of having a child who will be diagnosed with autism spectrum disorder (ASD). Previous research evaluating potential associations between maternal labor and delivery course with autism have been small and produced conflicting results. This study is the largest to date, assessing over ½ a million children’s labor courses, and utilized detailed data on perinatal conditions to control for numerous potential confounders.
Exclusion of certain racial and ethnic groups, including students outside of the public school system, may limit the generalizability. Additionally, study authors were unable to determine data on maternal medications and other potential confounders. Incidences of autism spectrum disorders were also not assessed. Future investigations could further develop this association by prospective evaluation of labor courses, including assessment of maternal medical conditions, labor medications, interventions and events to evaluate potential causal factors driving the association observed in this retrospective cohort.
Click to read the study in JAMA Pediatrics
Relevant Reading: Prenatal and perinatal risk factors for autism: a review and integration of findings
Study Authors, Dr. Simon Gregory, PhD, Duke Center for Human Genetics, Associate Professor, Section of Medical Genetics, Department of Medicine, and Dr. Chad Grotegut, M.D., Duke University, Assistant Professor, Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, talk to 2 Minute Medicine:
“The study’s results raise the possibility that the effects of maternal health and events at birth on the unborn infant may provide elevated risk of developing autism. Though we see an association, this does not mean that labor induction and/or augmentation causes autism. We do not know if the causative factor is the medical condition that ultimately required labor induction/augmentation, the medications utilized during or prior to the labor process, or events occurring in labor that may be more commonly associated with labor induction.”
In-Depth [retrospective cohort study]: This study analyzed North Carolina Detailed Birth Record data and North Carolina Education Research Data Center educational records for 318,870 male and 306,172 female children to assess the relationship between aspects of labor and delivery, including labor induction and/or augmentation, with autism incidence.
Overall, children whose mothers underwent labor induction and augmentation were more likely to be autistic (OR 1.27, CI 1.05-1.52;). Children whose mothers underwent labor induction only (OR 1.13, CI 1.04-1.22) or augmentation only (OR 1.16, CI 1.07-1.25) were also at increased odds for autism. When stratified by gender, these trends were similar among male children, but only augmented labor was associated with increased odds among female children (OR 1.18, CI 1.02 to 1.36).
By Denise Pong, MPH and Leah Hawkins, MD, MPH
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