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Perinatal risk factors for infantile autism
Christina M Hultman1, Pär Sparén, Sven Cnattingius
1Department of Medical Epidemiology, Karolinska Institutet, S-17277 Stockholm, Sweden. Christina.Hultman@mep.ki.se
Epidemiology (Cambridge, Mass.)
|July 3, 2002
Summary
Maternal smoking, foreign birth, cesarean delivery, and indicators of fetal distress like low Apgar scores increase autism risk. Intrauterine and neonatal factors are key in autism development.
Area of Science:
- Pediatric Epidemiology
- Neurodevelopmental Disorders
- Perinatal Health
Background:
- Infantile autism (autism spectrum disorder) has complex etiologies, with genetic and potential environmental factors implicated.
- Early fetal development and maternal/infant characteristics are hypothesized to influence autism risk.
Purpose of the Study:
- To evaluate the association between maternal, pregnancy, delivery, and infant characteristics and the risk of infantile autism.
- Investigate environmental and perinatal risk factors for autism spectrum disorder.
Main Methods:
- A population-based case-control study was conducted using prospectively recorded data from the Swedish Birth Register.
- Data were linked to the Swedish Inpatient Register for 408 autism cases and 2,040 matched controls born between 1974-1993.
- Conditional logistic regression analysis calculated odds ratios (ORs) and 95% confidence intervals (CIs).
Main Results:
- Increased autism risk was linked to maternal smoking in early pregnancy (OR=1.4), maternal birth outside Europe/North America (OR=3.0), and cesarean delivery (OR=1.6).
- Factors indicating fetal distress or abnormal growth, such as small for gestational age (OR=2.1) and a 5-minute Apgar score below 7 (OR=3.2), were associated with higher autism risk.
- Congenital malformations (OR=1.8) also showed an association, while head circumference, maternal diabetes, twin status, and birth season did not.
Conclusions:
- Findings suggest intrauterine and neonatal factors are significant in autism pathogenesis.
- Deviant intrauterine growth and fetal distress appear to be important contributors to the development of autism.