Induction, augmentation and autism…

puzzle_ribbonA study published in Obstetrical and Gynecological Survey this week which analysed birth and educational records has shown that children born to mothers who were induced, augmented or both had increased odds of having autism (Gregory et al 2014).  As the authors themselves point out, we always have to be a bit careful how we interpret research of this nature, but the finding that a child born to a woman whose labour was induced and augmented had 23% higher odds of being diagnosed as having autism than a child born to a woman who didn’t have these interventions is one that should perhaps get our attention.  Especially as both of these interventions seem to be used so casually these days, despite increasing evidence that they can cause a whole range of short and long term issues.

I want to be very clear about a couple of things though, because the subject of autism is very close to my heart and I am concerned about the way in which such research findings are sometimes interpreted by certain people or organisations claiming to speak for people who have autism.

  • By highlighting this study, I am not implying that autism is something terrible which we should necessarily be attempting to prevent.  Far, far from it.  Such a viewpoint has been expressed in relation to many other differences, diseases or disabilities as well, and it insults the people who live with these differences on so many levels.  An autism-free world would be a very boring one indeed and, if we would only stop spouting received wisdom and listen, there is much that we can learn about how differences such as autism can confer advantages and be equally but differently valid ways of being, seeing or knowing.
  • I am also not wanting my post to cause the word ‘should’ to enter anyone’s head…  I want to send a hug to any woman who has a child with autism who reads this and (for the millionth time) asks herself if this is why it happened, and if she should have made different choices.  If this is you, I’d like to whisper in your ear that you couldn’t have known, that you didn’t do anything wrong, and that it’s truly not your fault.

But I am concerned that we already interfere too much in birth, that some of this interference is unnecessary and that women who give birth in the future deserve to know such things before they decide whether or not to consent to non-lifesaving drugs and interventions that have such knock-on effects.  I think it is entirely possible to love, value and celebrate difference in general and neurodiversity in particular without necessarily wanting to choose interventions that create more of it than would occur naturally.  But that’s just my standpoint…

The study:

Autism spectrum disorders encompass well-known behavioral and cognitive disturbances. Heritable and environmental factors may influence normal development or alter regulatory processes, with environmental factors perhaps exerting their effect during the prenatal and early postnatal periods. This study focused on the association between autism and labor induction or augmentation or both using a population-based data set of linked child educational and birth records from North Carolina to investigate whether birth induction/augmentation is associated with increased odds of being diagnosed with autism.

Demographic and obstetric data were obtained from all recorded live births occurring in North Carolina. Information on autism diagnosis was extracted from statewide educational records. Birth records from 1990 to 1998 were linked with educational data from the 1997 to 1998 to 2007 to 2008 academic years for the entire state (match rate, 74.4%). An individual met special needs eligibility criteria by having deficits in 3 of the 4 areas: communication, social reciprocity, behavior, or sensory. During delivery, a mother was either not induced or augmented (reference), induced only, or augmented only, or both induced and augmented. The association between induction/augmentation was examined in a range of models with such specifications as (1) only induction/augmentation and infant sex; (2) adding standard maternal-level characteristics; (3) adding maternal medical conditions and health behaviors affecting the pregnancy; (4) expanding model 3 to control for events of labor and delivery; (5) adding to 4 an ordinal variable for child birth year; and (6) adding an interaction between infant sex and induction/augmentation.

About 1.3% and 0.4% of male and female children had autism, respectively. For both sexes, the percentage of induced or augmented mothers was higher among children with autism compared with noncases. In model 1, a child whose mother was induced and augmented during delivery had 23% higher odds of being diagnosed as having autism than a child whose mother was neither induced nor augmented (odds ratio [OR], 1.23; 95% CI, 1.02–1.47). The ORs for the induced-only and augmented-only categories were 1.10 (95% CI, 1.01–1.19) and 1.15 (95% CI, 1.07–1.24), respectively. Compared with girls, boys had increased odds of autism diagnosis (OR, 3.04; 95% CI, 2.86–3.24). In models 2 to 4, including potential confounders related to socioeconomic status, maternal health, and pregnancy-related events/conditions did not significantly change the ORs for induction/augmentation from those in model 1. In model 5, a child whose mother was both induced and augmented at delivery had 27% higher odds of being diagnosed as having autism (OR, 1.27; 95% CI, 1.05–1.52). The ORs for the induced-only and augmented-only categories indicated a 13% to 16% increase in the odds of autism, respectively. Fetal distress and meconium were associated with autism with ORs of 1.25 and 1.22, respectively (95% CIs, 1.15–1.36 and 1.11–1.34, respectively).

Children born to mothers who were either induced, augmented, or both had increased odds of having autism. Further research should target the agents used during induction/augmentation and acute medical and obstetric events during labor. The results do not suggest altering the standards of care for induction or augmentation but do indicate that additional research is warranted.

Gregory SG, Anthopolos R, Osgood CE et al (2014). Association of Autism With Induced or Augmented Childbirth in North Carolina Birth Record (1990–1998) and Education Research (1997–2007) Databases.  Obstetrical & Gynecological Survey 69(1):7-9. doi: 10.1097/01.ogx.0000442814.50107.fa

8 comments for “Induction, augmentation and autism…

  1. January 6, 2014 at 8:03 pm

    Reblogged this on Endless Journey and commented:
    Just found this blog and thought I would share. I was induced and augmented with the birth of Silas…

    • January 6, 2014 at 8:38 pm

      That’s a big hug for you then…

  2. Sooz
    January 7, 2014 at 8:42 pm

    Interesting! I also read a recent study on oxytocin treatment improving symptoms of autism…….wonder if there’s a link there? I’ll have to go find the other study again now 🙂
    I too had an induction for my autistic boy, whether this is part of the reason, well, who knows? What I do know, autism aside, is that had I known then what I know now in regards to intervention (he was born before I became a midwife), I never would have done it. We interfere too much in birth nowadays.

    • January 7, 2014 at 9:17 pm

      Indeed… I was talking to the lovely Sarah Buckley about that research this summer and, anecdotally, my favourite person who has autism finds himself much more able to relax and focus when he engages in activities that are associated with oxytocin release…

  3. Debbie
    January 7, 2014 at 11:38 pm

    Gave birth to 7 children, 1 in Germany and 6 in Sweden. In Sweden, a midwife does all the birthing and they do not induce until the baby has gone over 21 days. At 17 days over, they decided to induce my 6th child who ended weighing 11 lbs, 15 oz. (can we just say 12 pounds??). The Swedish midwives told me that in Sweden a pregnancy is treated as a part of life with little intervention and in many other countries it is treated like an illness. Love all my Swedish midwives! Seeing that 5 of my babies were over 10 pounds, I was thankful that they were patient and willing to help me deliver all of my big babies naturally!

    • January 8, 2014 at 6:58 am

      Absolutely, Debbie! We seem to have lost the ability to be patient in some areas, for lots of reasons… It’s great to hear that you loved your Swedish midwives!

  4. sarah
    January 9, 2017 at 3:02 pm

    I’ve suspected this for a long time. I have 3 separate friends who gave birth in different hospitals and one in the US and two in the UK. All three had really surprisingly similar birth experiences (induced, traumatic labour, forceps) and at around 2.5/3 all 3 had sons diagnosed with spectrum disorders. They are all gorgeous children, and it is definitely not to blame the mother- but I do wonder why people think induction is such a great solution…. and why hospitals bang on about it in such a forceful and pressurised way.

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