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Obstetric complications in autism: consequences or causes of the condition?
P F Bolton1, M Murphy, H Macdonald
1Developmental Psychiatry Section, University of Cambridge, U.K.
Insights
Obstetric complications are linked to autism, but may not be a primary cause. These complications might be a byproduct of autism or share common risk factors.
Area of Science:
- Neurodevelopmental disorders
- Genetics and epigenetics
- Perinatal medicine
Background:
- Autism Spectrum Disorder (ASD) is a complex neurodevelopmental condition.
- The role of obstetric complications in ASD etiology remains debated.
- Down Syndrome (DS) serves as a comparative neurodevelopmental condition.
Purpose of the Study:
- To investigate the association between obstetric complications and autism.
- To explore potential underlying reasons for this association.
- To compare obstetric complication patterns in autism and Down Syndrome.
Main Methods:
- Utilized an Optimality Score (OS) to quantify obstetric histories from maternal interviews.
- Compared OS in families with autistic probands (n=78) versus Down Syndrome probands (n=27).
- Examined OS in relation to diagnosis, proband characteristics, and familial loading for autism and its variants.
Main Results:
- Autistic and DS probands showed significantly elevated OS compared to unaffected siblings.
- Mild obstetric adversities contributed more to the elevated OS than severe ones.
- Familial loading for autism and autistic symptoms best predicted OS in autistic probands.
Conclusions:
- Obstetric complications are unlikely to be a principal etiological factor in autism.
- The observed association may be an epiphenomenon or stem from shared risk factors.
- Further research is needed to elucidate the complex interplay of genetic and environmental factors.
Objective:
To determine whether and why obstetric complications are associated with autism.
Method:
Obstetric histories, obtained at maternal interview and coded as an optimality score (OS), were compared in two groups: 78 families containing an autistic proband (ICD-10 criteria) and 27 families containing a down syndrome (DS) proband. The OS was examined in relation to offspring diagnosis, proband characteristics, and familial loading for autism and its phenotypic variants.
Results:
Autistic and DS probands had a significantly elevated OS compared with unaffected siblings, regardless of birth order position. The elevation was mainly due to an increase in mild as opposed to severe obstetric adversities. In autistic probands, the OS was best predicted by familial loading for autism and its phenotypic variants, but in the absence of this measure by the number of autistic symptoms. Among siblings of autistic probands affected with autism or its variants, the OS was best predicted by the probands' OS, and in its absence, by the measure of familial loading. In DS probands and siblings the OS was associated with increased maternal age, although this did not account for the OS elevation in DS probands.
Conclusions:
Rather than playing any principal etiological role, the obstetric adversities associated with autism either represent an epiphenomenon of the condition or derive from some shared risk factor(s).