Perinatal Factors and the Development of Autism: A Population Study | Autism Spectrum Disorders | JAMA Psychiatry | JAMA Network
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Original Article
June 2004

Perinatal Factors and the Development of Autism: A Population Study

Author Affiliations

From the Schools of Population Health (Dr Glasson) and Psychiatry andClinical Neurosciences (Drs Glasson and Hallmayer), and the Telethon Institutefor Child Health Research, Centre for Child Health Research (Drs Glasson,Bower, Petterson, and de Klerk), University of Western Australia, Perth, Australia;the Centre for Clinical Research in Neuropsychiatry, Graylands Hospital, Perth(Drs Glasson and Hallmayer); the Disability Services Commission, Perth (DrPetterson); Princess Margaret Hospital, Perth (Dr Chaney); and the Departmentof Psychiatry and Behavioral Sciences, Stanford University School of Medicine,Stanford, Calif (Dr Hallmayer). Dr Glasson is no longer with the Centre forClinical Research in Neuropsychiatry, Graylands Hospital, Perth.

Arch Gen Psychiatry. 2004;61(6):618-627. doi:10.1001/archpsyc.61.6.618
Abstract

Background  Autism is considered to have a genetic basis, although exposure to certain stimuli in the prenatal period has been implicated to be causal in some cases. Some investigations have shown an association with obstetric complications but findings have been inconsistent owing to differences in sampling and methods.

Objective  To examine the association of obstetric factors with autism spectrum disorders for a cohort of children, using obstetric data contained in a statutory database collected at the time of birth.

Design  Subjects born in Western Australia between 1980 and 1995 and diagnosed with an autism spectrum disorder by 1999 were included as cases (n = 465). Siblings of the cases (n = 481) and a random population-based control group (n = 1313) were compared with the cases on obstetric information contained in the Maternal and Child Health Research Database of Western Australia.

Results  Compared with control subjects, cases had significantly older parents and were more likely to be firstborn. Case mothers had greater frequencies of threatened abortion, epidural caudal anesthesia use, labor induction, and a labor duration of less than 1 hour. Cases were more likely to have experienced fetal distress, been delivered by an elective or emergency cesarean section, and had an Apgar score of less than 6 at 1 minute. Cases with a diagnosis of autism had more complications than those with pervasive developmental disorder not otherwise specified or Asperger syndrome. Nonaffected siblings of cases were more similar to cases than control subjects in their profile of complications.

Conclusions  Autism is unlikely to be caused by a single obstetric factor. The increased prevalence of obstetric complications among autism cases is most likely due to the underlying genetic factors or an interaction of these factors with the environment.

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