A 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…
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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.