Published online April 27, 2009
PEDIATRICS Vol. 123 No. 5 May 2009, pp. 1293-1300 (doi:10.1542/peds.2008-0927)
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ARTICLE

Prenatal, Perinatal, and Neonatal Factors Associated With Autism Spectrum Disorders

Deborah Bilder, MD, Judith Pinborough-Zimmerman, PhD, Judith Miller, PhD and William McMahon, MD

Division of Child and Adolescent Psychiatry, Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, Utah

OBJECTIVE. To investigate prenatal, perinatal, and neonatal risk factors for autism spectrum disorders by using participants identified through broad ascertainment and reliable classification methods.

METHODS. The targeted population was 8-year-old children born in 1994 and residing in 1 of the 3 most populous counties in Utah who were identified as having an autism spectrum disorder on the basis of methodology used by the 2002 Autism and Developmental Disabilities Monitoring Network. Of those identified, 132 children (115 boys, 17 girls) had birth certificate records available. Each child was matched by gender and birth year to 100 controls (11 500 boys, 1700 girls) from the birth certificate database in a nested case-control design. Birth certificate records of participants and controls were surveyed for 23 potentially pathologic prenatal, perinatal, and neonatal factors.

RESULTS. The prenatal factors that occurred significantly more frequently among children with autism spectrum disorders were advanced maternal age and parity. Increased duration of education among mothers of children with autism spectrum disorders was small but statistically significant. Significant perinatal factors were breech presentation and primary cesarean delivery. When corrected for breech presentation, a known indication for cesarean delivery, the association between primary cesarean delivery and autism spectrum disorders was eliminated. There were no significant associations found between autism spectrum disorders and neonatal factors.

CONCLUSIONS. In the absence of other complications suggesting fetal distress, the association between breech presentation and autism spectrum disorders in this study suggests a shared etiology rather than causal relationship. Additional investigation focused on both genetic and environmental factors that link these autism spectrum disorder risk factors individually or collectively is needed.

Key Words: autism • risk factors • Utah

Abbreviations: ASD—autism spectrum disorder • ICD—International Classification of Diseases • DSM-III—Diagnostic and Statistical Manual of Mental Disorders, Third Edition • DSM-III-R—Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition • DSM-IV-TR—Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision • ADDM—Autism and Developmental Disabilities Monitoring Network • CDC—Centers for Disease Control and Prevention • PDD—pervasive developmental disorder • NOS—not otherwise specified • OR—odds ratio • CI—confidence interval

Accepted Aug 28, 2008.


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