Introduction
Cesarean section and induced deliveries have increased substantially in the U.S.,
coinciding with increases in autism spectrum disorder. Studies have documented associations
between cesarean section deliveries and autism spectrum disorder but have not comprehensively
accounted for medical risks. This study evaluates the extent to which cesarean section
and induced deliveries are associated with autism spectrum disorder in low-risk births.
Methods
In this retrospective cohort study, California's birth records (1992–2012) were linked
to hospital discharge records to identify low-risk births using a stringent algorithm
based on Joint Commission guidelines. Autism spectrum disorder status was based on
California Department of Developmental Service data. Logistic regression models were
used to estimate associations between autism spectrum disorder and induced vaginal
deliveries, cesarean section deliveries not following induction, and cesarean section
deliveries following induction, with noninduced vaginal deliveries as the reference
category.
Results
A total of 1,488,425 low-risk births took place in California from 1992 to 2012. The
adjusted odds of autism spectrum disorder were 7% higher for induced vaginal deliveries
(AOR=1.07, 95% CI=1.01, 1.14), 26% higher for cesarean section deliveries not following
induction (AOR=1.26, 95% CI=1.19, 1.33), and 31% higher for cesarean section deliveries
following induction (AOR=1.31, 95% CI=1.18, 1.45) than for noninduced vaginal deliveries.
Lower gestational age and neonatal morbidities did not appear to be important underlying
pathways. The associations were insensitive to alternative model specifications and
across subpopulations. These results suggest that, in low-risk pregnancies, up to
10% of autism spectrum disorder cases are potentially preventable by avoiding cesarean
section deliveries.
Conclusions
After accounting for medical risks, elective deliveries—particularly cesarean section
deliveries—were associated with a substantially increased risk of autism spectrum
disorder.
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Article Info
Publication History
Published online: March 30, 2022
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