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Adverse labor events and childhood autism - is there a link?

Hagar Brami1, Omri Zamstein1, Tamar Wainstock2

  • 1Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben Gurion University of the Negev, Beer-Sheva, Israel.

European Journal of Obstetrics, Gynecology, and Reproductive Biology
|August 16, 2025
PubMed

Insights

Adverse perinatal outcomes, such as low Apgar scores or cord blood pH, were not associated with an increased risk of autism spectrum disorder (ASD) in children. This large study found no link between difficult births and later ASD diagnoses.

Area of Science:

  • Perinatal Medicine
  • Neurodevelopmental Disorders
  • Pediatric Epidemiology

Background:

  • Autism spectrum disorder (ASD) prevalence is increasing globally, yet its underlying mechanisms and perinatal risk factors remain unclear.
  • Understanding potential links between adverse perinatal events and ASD is crucial for early identification and intervention strategies.

Purpose of the Study:

  • To investigate the association between unfavorable perinatal outcomes and the risk of developing autism spectrum disorder (ASD) in childhood.
  • To analyze if specific adverse perinatal events correlate with a higher incidence of ASD diagnoses.

Main Methods:

  • A population-based cohort analysis included 165,989 births.
  • Adverse perinatal outcomes were defined as 5-min Apgar scores <7, umbilical cord blood pH <7.0, or non-reassuring fetal heart rate requiring intervention.
  • Kaplan-Meier survival curves and Cox proportional hazards models were used to assess ASD incidence and control for confounders.

Main Results:

  • Out of 165,989 births, 6.7% experienced adverse perinatal outcomes, often associated with intrauterine growth restriction, preterm delivery, and cesarean delivery.
  • A total of 862 offspring were diagnosed with ASD.
  • No statistically significant association was found between adverse perinatal outcomes and the risk of ASD (adjusted HR = 0.96, 95% CI 0.75-1.22, p=0.72).

Conclusions:

  • Adverse labor events, while critical for immediate neonatal health, do not appear to increase the long-term risk of autism spectrum disorder in children.
  • The study suggests that factors beyond immediate perinatal complications may be more influential in the etiology of ASD.
Abstract

Keywords:
Adverse labor eventsAutismDelivery

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