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Comment & Response |

Induction or Augmentation of Labor and Autism

George R. Saade, MD1; Baha M. Sibai, MD2; Robert Silver, MD3
[+] Author Affiliations
1Department of Obstetrics and Gynecology, The University of Texas Medical Branch, Galveston
2Department of Obstetrics and Gynecology, University of Texas Health Sciences at Houston, Houston
3Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City
JAMA Pediatr. 2014;168(2):190-191. doi:10.1001/jamapediatrics.2013.4800.
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To the Editor Autism is a major problem with apparently increasing prevalence. Accordingly, the association between labor induction/augmentation and autism reported by Gregory et al1 deserves further investigation. However, the results should be interpreted with great caution because of limitations in the study design. One of the most important limitations is that data were obtained from birth records in North Carolina that were previously “validated.” The cited validation involved assessment of agreement between selected variables in birth records and matched data from the same women enrolled in a cohort study.2 In the validation study, only 87% of the participants were successfully matched to the birth records (13% error rate). Many of the variables in the analysis by Gregory et al were actually never validated, including variables such as febrile, meconium, fetal distress, and placental abruption. Diabetes was one of the supposedly validated variables, but its κ was only 0.09. This is particularly important given that gestational diabetes has been associated with autism. More importantly, the variable induction/augmentation was never validated. This variable and the indications for induction/augmentation are often inaccurate in birth records.3,4

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February 1, 2014
Marie Lynn Miranda, PhD; Rebecca Anthopolos, MA; Simon G. Gregory, PhD
1Department of Pediatrics, University of Michigan, Ann Arbor2Children’s Environmental Health Initiative, School of Natural Resources and Environment, University of Michigan, Ann Arbor
2Children’s Environmental Health Initiative, School of Natural Resources and Environment, University of Michigan, Ann Arbor
3Center for Human Genetics, Department of Medicine, Duke University Medical Center, Durham, North Carolina4Duke Institute of Molecular Physiology, Duke University Medical Center, Durham, North Carolina
JAMA Pediatr. 2014;168(2):191-192. doi:10.1001/jamapediatrics.2013.4792.
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