Induced Labor Linked to Increased Risk for Autism
Induced labor and/or augmentation during childbirth may be linked to an increased risk for autism spectrum disorder (ASD) in children, new research suggests. However, researchers are quick to point out that more research is needed before any conclusions regarding causality can be drawn.
A retrospective study of more than 625,000 live births showed that children of mothers who received labor augmentation and induction had 23% increased odds of having ASD than children whose mothers did not undergo induced or augmented labor.
In addition, this association was even stronger in boys.
“We’re hoping this can contribute to discussion about the environmental factors which could contribute to the development of autism or to a subset of the ASDs,” lead author Simon G. Gregory, PhD, associate professor at the Duke Institute of Molecular Physiology at Duke University Medical Center in Durham, North Carolina, told Medscape Medical News.
It’s a complex disorder that can be a combination of genes and the environment. And it could be that what we’re seeing is an environmental factor that’s contributing to elevated risk, whether or not it’s on top of a genetic predisposition. With all of these diseases, it’s important to chip away at what the causes are.
However, further research is needed to differentiate among potential explanations of the association, including underlying pregnancy conditions, events leading up to the induction/augmentation, and specific medications and dosing patterns used.
According to the investigators, approximately 1 out of every 88 children in the United States has ASD. Previous studies have examined both genetic and environmental factors that may influence the development of ASD — and led the current researchers to assess a possible link with induction and/or augmentation during childbirth.
Induction is “stimulating uterine contractions prior to the onset of spontaneous labor,” and augmentation is “increasing the strength, duration, or frequency of uterine contractions.”
Results showed that after controlling for male sex only, children of mothers who underwent induction and augmentation had significantly higher odds of being diagnosed with autism than children whose mothers did not undergo induction or augmentation (odds ratio [OR], 1.23; 95% confidence interval [CI], 1.02 – 1.47).
Compared with the “neither induced nor augmented” category, the induced-only and augmented-only categories had ORs of 1.10 and 1.15, respectively.
In addition, “the inclusion of successive sets of potential confounders related to socioeconomic status, maternal health, and pregnancy-related events and conditions did not substantively alter the estimated ORs,” report the researchers.
One possible explanation for the induction/augmentation-ASD association is through exposure to exogenous oxytocin It should be noted that 50% to 70% of women who undergo induction receive this medication. And past research has suggested that it is a contributor to the development of ASD.
Compared with mothers who did not have diabetes mellitus, those with the condition had 23% higher odds of having a child with autism.
Still, we don’t want moms to worry and at the time of birth and say, ‘Don’t induce because it will cause autism.’ Negative consequences of not inducing can far outweigh those risks.
JAMA Pediatr. Published online August 12, 2013. Abstract
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