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Original Investigation |

Association of Autism With Induced or Augmented Childbirth in North Carolina Birth Record (1990-1998) and Education Research (1997-2007) Databases

Simon G. Gregory, PhD1,2; Rebecca Anthopolos, MA3; Claire E. Osgood, BS4; Chad A. Grotegut, MD5; Marie Lynn Miranda, PhD3,6
[+] Author Affiliations
1Center for Human Genetics, Department of Medicine, Duke University Medical Center, Durham, North Carolina
2Duke Institute of Molecular Physiology, Duke University Medical Center, Durham, North Carolina
3Children’s Environmental Health Initiative, School of Natural Resources and Environment, University of Michigan, Ann Arbor
4Children’s Environmental Health Initiative, Duke University, Durham, North Carolina
5Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, North Carolina
6Children’s Environmental Health Initiative, School of Natural Resources and Environment and Department of Pediatrics, University of Michigan, Ann Arbor
JAMA Pediatr. 2013;167(10):959-966. doi:10.1001/jamapediatrics.2013.2904.
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Importance  One in 88 children in the United States is diagnosed as having autism spectrum disorder. Significant interest centers on understanding the environmental factors that may contribute to autism risk.

Objective  To examine whether induced (stimulating uterine contractions prior to the onset of spontaneous labor) and/or augmented (increasing the strength, duration, or frequency of uterine contractions with spontaneous onset of labor) births are associated with increased odds of autism.

Design, Setting, and Participants  We performed an epidemiological analysis using multivariable logistic regression modeling involving the North Carolina Detailed Birth Record and Education Research databases. The study featured 625 042 live births linked with school records, including more than 5500 children with a documented exceptionality designation for autism.

Exposures  Induced or augmented births.

Main Outcomes and Measures  Autism as assessed by exceptionality designations in child educational records.

Results  Compared with children born to mothers who received neither labor induction nor augmentation, children born to mothers who were induced and augmented, induced only, or augmented only experienced increased odds of autism after controlling for potential confounders related to socioeconomic status, maternal health, pregnancy-related events and conditions, and birth year. The observed associations between labor induction/augmentation were particularly pronounced in male children.

Conclusions and Relevance  Our work suggests that induction/augmentation during childbirth is associated with increased odds of autism diagnosis in childhood. While these results are interesting, further investigation is needed to differentiate among potential explanations of the association including underlying pregnancy conditions requiring the eventual need to induce/augment, the events of labor and delivery associated with induction/augmentation, and the specific treatments and dosing used to induce/augment labor (eg, exogenous oxytocin and prostaglandins).

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Figure.
Filtering Process of Data Included in This Study From the North Carolina (NC) Detailed Birth Record (DBR) and Education Research Data Center Databases

We limited the data set to mothers between the ages of 15 and 49 years, infants weighing at least 400 g at delivery, and infants born at between 24 and 42 weeks’ gestation. Births with congenital anomalies were also excluded. We removed records with missing information on key covariates including infant sex, multiple births, maternal education, maternal marital status, maternal smoking status, parity, and mode of delivery. The 1732 records excluded owing to missing covariate information were more likely to have a positive autism diagnosis and less likely to have been induced or augmented than those in the final data set (1.5% vs 0.9% and 19% vs 29%, respectively).

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