Induced Labor and Other Autism Risk Factors, What Women Can Do

Autism and induced labor
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It seems like news about possible risk factors for autism crop up in the news on a regular basis, and a potential new one has just been reported. Researchers now suggest that induced or augmented labor may increase a woman’s chances of giving birth to an infant who has autism, especially if the child is a male.

What you should know about induced labor and autism

For a variety of reasons, some pregnant women may require induced labor, which means doctors stimulate contractions before labor has started naturally. Augmented labor refers to methods used to increase the duration, frequency, or strength of a woman’s contractions.

Methods to induce or augment labor may include the use of drugs (e.g, dinoprostone, oxytocin), breaking a woman’s water, or use of a cervical balloon, among others. These and other options should be fully discussed between a pregnant woman and her doctors.

According to the National Center for Health Statistics, 23.1 percent of all births in the United States in 2008 involved induced labor. The most common reasons for inducing labor are being past due or the presence of fetal distress that threatens the health of the infant.

In the new study, experts at Duke University and University of Michigan evaluated the birth records of 625,042 infants born between 1990 and 1998 in North Carolina and compared them with reports of autism from public schools. Here’s what they found:

  • 1.3% of boys and 0.4% of girls had been diagnosed with autism
  • Boys born to women who had undergone induced or augmented labor were 35% more likely to develop autism when compared with women who had had normal labor
  • Among girls, augmented labor, but not induced labor, was associated with an increased risk of autism
  • The noted increased risk of autism remained even after the investigators accounted for other factors, such as mother’s age

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Do these results suggest women should avoid induced or augmented labor? The authors pointed out that their findings do not prove induced or augmented labor cause autism, but that there seems to be an association.

Simon Gregory, an associate professor of medicine and medical genetics at Duke University and the study’s lead author, explained that women should not avoid induced or augmented labor based on these findings. “In the vast majority of cases, pregnancy should be induced or augmented for cogent medical reasons, and if it isn’t, the risk to mother and child is significantly worse than risk for developing autism.”

In fact, experts believe autism is caused by a cumulative effect of environmental and genetic factors. Women who plan to become pregnant should be aware of these potential risk factors and discuss them with their family and healthcare providers.

Risk factors for autism women should know
Here are some of the risk factors for autism that experts have identified thus far. It’s important to note that women do have control over some of these factors and thus can make informed choices.

  • Age: Women older than 35 who have children are at increased risk of giving birth to a child who develops autism
  • Spaced births: The risk of autism appears to increase when women do not space out their pregnancies. For example, one study found that among women who became pregnant within one year of giving birth, the risk of having a child with autism was about 7.6 in every 1,000 compare with 2.5 out of every 1,000 among women who waited three years or longer to get pregnant again
  • Use of antidepressants: A Kaiser Permanente study revealed that women who used selective serotonin reuptake inhibitors (SSRIs; e.g., Celexa, Paxil, Prozac) while pregnant had a 2.2-fold increased risk of giving birth to a child who developed autism, and that risk rose to 3.8-fold when antidepressants were used during the first trimester.
  • Epilepsy and use of valproate: Research has shown that children exposed to valproate (a drug used to treat epilepsy) during pregnancy were six times more likely to have a neurodevelopmental disorder such as autism. When children were exposed to valproate as well as other antiseizure drugs, they were 10 times more likely to develop a neurodevelopmental disorder than those born to women who did not have epilepsy
  • Fever during pregnancy: A University of California Davis study reported that women who experienced fever during pregnancy had a greater than twofold chance of giving birth to a child with autism or developmental delays than women who did not have a fever or who took medication to reduce it.
  • Genetics: Thus far, scientists have identified several genes and genetic mutations that may be involved in causing autism
  • Perfumes and cosmetics: This is one of the newest potential risk factors. Two reports from scientists at the South Carolina Center for Biotechnology have proposed that substances—many of which are suspected or known toxins--found in perfumes and cosmetics may have a role in causing autism.

Much is still unknown about what causes autism and the steps women can take to help prevent its development. The new findings concerning induced labor as well as previous research indicating other potential risk factors for autism provide women, their families, and their doctors a starting point on how to help ward off this neurodevelopmental disorder.

SOURCES
Bagasra O et al. Role of perfumes in pathogenesis of autism. Medical Hypotheses 2013 Jun; 80(6): 795-803
Bagasra O, Pace DG. Smell of autism: Synthetic fragrances and cause for allergies, asthma, cancer and autism. OA Autism 2013 Jun 19; 1(2):15
Bromley RL et al. The prevalence of neurodevelopmental disorders in children prenatally exposed to antiepileptic drugs. Journal of Neurology Neurosurgery and Psychiatry 2013 Jan 31. DOI:10.1136/jnnp-2012-304270
Duke University
Gregory SG et al. Induced or augmented childbirth appears to be associated with increased risk for autism. JAMA Pediatrics 2013 Aug 12 Epub before print
National Center for Health Statistics

Image: Morguefile

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