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Elective Deliveries and the Risk of Autism.

Ka-Yuet Liu¹, Julien O Teitler², Sivananda Rajananda³

¹Department of Sociology, College of Social Sciences, University of California, Los Angeles, Los Angeles, California; California Center for Population Research, College of Social Sciences, University of California, Los Angeles, Los Angeles, California; RIKEN Center for Brain Science (CBS), Wako, Japan.

American Journal of Preventive Medicine

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Summary

Cesarean and induced deliveries are linked to a higher risk of autism spectrum disorder (ASD) in low-risk births. Avoiding these procedures could potentially prevent a significant percentage of ASD cases.

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Area of Science:

Obstetrics and Gynecology
Developmental Pediatrics
Public Health

Background:

Cesarean section and induced deliveries have risen significantly in the U.S.
Concurrent increases in autism spectrum disorder (ASD) have been observed.
Previous studies noted associations between cesarean deliveries and ASD, but often did not fully account for medical risks.

Purpose of the Study:

To evaluate the association between cesarean section and induced deliveries with autism spectrum disorder (ASD) in low-risk pregnancies.
To determine if medical risks confound the relationship between delivery mode and ASD.
To estimate the potential impact of delivery mode on ASD prevalence in low-risk births.

Main Methods:

Retrospective cohort study utilizing California birth and hospital discharge records (1992-2012).
Identification of low-risk births based on stringent criteria.
Logistic regression models analyzed associations between ASD and different delivery types (induced vaginal, non-induced cesarean, induced cesarean) versus non-induced vaginal delivery.

Main Results:

A total of 1,488,425 low-risk births were analyzed.
Induced vaginal deliveries showed a 7% higher odds of ASD (AOR=1.07).
Cesarean deliveries not following induction had 26% higher odds (AOR=1.26), and those following induction had 31% higher odds (AOR=1.31).
Associations remained significant after controlling for gestational age and neonatal morbidities.

Conclusions:

Elective deliveries, especially cesarean sections, are associated with a substantially increased risk of autism spectrum disorder in low-risk pregnancies, even after accounting for medical factors.
These findings suggest that up to 10% of autism spectrum disorder cases in low-risk births may be preventable by avoiding cesarean section deliveries.