Abstract
A succession of interconnected environmental factors is believed to contribute substantially to the development of autism spectrum disorder (ASD). This exploratory study therefore aims to identify potential risk factors for ASD that are associated with pregnancy, birth and infant feeding. Demographic and health-related data on children aged 3–13 years (N = 4306) was collected through an online survey completed by biological mothers. A fitted logistic regression model identified advanced maternal age, prenatal bleeding, pre-eclampsia, perinatal pethidine usage, foetal distress before birth and male sex of child as associated with an increased risk of ASD, whereas longer gestational duration demonstrated a protective effect. These findings highlight potential risk factors and predictor interrelationships which may contribute to overall ASD risk.
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References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). American Psychiatric Publishing.
Armstrong-Wells, J., Bernard, T. J., Boada, R., & Manco-Johnson, M. (2010). Neurocognitive outcomes following neonatal encephalopathy. NeuroRehabilitation, 26(1), 27–33. https://doi.org/10.3233/NRE-2010-0533
Bölte, S., Girdler, S., & Marschik, P. B. (2019). The contribution of environmental exposure to the etiology of autism spectrum disorder. Cellular and Molecular Life Sciences, 76(7), 1275–1297. https://doi.org/10.1007/s00018-018-2988-4
Brown, C. M., & Austin, D. W. (2009). Commentary: Fatty acids, breastfeeding and autism spectrum disorder. E-Journal of Applied Psychology: Clinical and Social Issues, 5(1), 49–52.
Carlsson, T., Molander, F., Taylor, M. J., Jonsson, U., & Bölte, S. (2020). Early environmental risk factors for neurodevelopmental disorders—A systematic review of twin and sibling studies. Development and Psychopathology. https://doi.org/10.1017/S0954579420000620
Chaste, P., & Leboyer, M. (2012). Autism risk factors: Genes, environment, and gene-environment interactions. Dialogues in Clinical Neuroscience, 14(3), 281–292.
Cheroni, C., Caporale, N., & Testa, G. (2020). Autism spectrum disorder at the crossroad between genes and environment: Contributions, convergences, and interactions in ASD developmental pathophysiology. Molecular Autism, 11(1), 1–18. https://doi.org/10.1186/s13229-020-00370-1
Curran, E. A., O’Neill, S. M., Cryan, J. F., Kenny, L. C., Dinan, T. G., Khashan, A. S., & Kearney, P. M. (2015). Research review: Birth by caesarean section and development of autism spectrum disorder and attention-deficit/hyperactivity disorder: A systematic review and meta-analysis. Journal of Child Psychology and Psychiatry, 56(5), 500–508. https://doi.org/10.1111/jcpp.12351
Dachew, B. A., Mamun, A., Maravilla, J. C., & Alati, R. (2018). Pre-eclampsia and the risk of autism-spectrum disorder in offspring: Meta-analysis. The British Journal of Psychiatry, 212(3), 142–147. https://doi.org/10.1192/bjp.2017.27
Dahlen, H. G., Thornton, C., Downe, S., De Jonge, A., Seijmonsbergen-Schermers, A., Tracy, S., Tracy, M., Bisits, A., & Peters, L. (2021). Intrapartum interventions and outcomes for women and children following induction of labour at term in uncomplicated pregnancies: A 16-year population-based linked data study. British Medical Journal Open, 11(6), e047040. https://doi.org/10.1136/bmjopen-2020-047040
Fleet, J. A., Jones, M., & Belan, I. (2017). The influence of intrapartum opioid use on breastfeeding experience at 6 weeks post partum: A secondary analysis. Midwifery, 50, 106–109. https://doi.org/10.1016/j.midw.2017.03.024
Gardener, H., Spiegelman, D., & Buka, S. L. (2009). Prenatal risk factors for autism: Comprehensive meta-analysis. The British Journal of Psychiatry, 195(1), 7–14. https://doi.org/10.1192/bjp.bp.108.051672
Gardener, H., Spiegelman, D., & Buka, S. L. (2011). Perinatal and neonatal risk factors for autism: A comprehensive meta-analysis. Pediatrics, 128(2), 344–355. https://doi.org/10.1542/peds.2010-1036
Getahun, D., Fassett, M. J., Peltier, M. R., Wing, D. A., Xiang, A. H., Chiu, V., & Jacobsen, S. J. (2017). Association of perinatal risk factors with autism spectrum disorder. American Journal of Perinatology, 34(3), 295–304. https://doi.org/10.1055/s-0036-1597624
Gregory, S. G., Anthopolos, R., Osgood, C. E., Grotegut, C. A., & Miranda, M. L. (2013). Association of autism with induced or augmented childbirth in North Carolina Birth Record (1990–1998) and Education Research (1997–2007) databases. JAMA Pediatrics, 167(10), 959–966. https://doi.org/10.1001/jamapediatrics.2013.2904
Hallmayer, J., Cleveland, S., Torres, A., Phillips, J., Cohen, B., Torigoe, T., Miller, J., Fedele, A., Collins, J., Smith, K., Lotspeich, L., Croen, L. A., Ozonoff, S., Lajonchere, C., Grether, J. K., & Risch, N. (2011). Genetic heritability and shared environmental factors among twin pairs with autism. Archives of General Psychiatry, 68(11), 1095–1102. https://doi.org/10.1001/archgenpsychiatry.2011.76
Hermus, M. A., Verhoeven, C. J., Mol, B. W., de Wolf, G. S., & Fiedeldeij, C. A. (2009). Comparison of induction of labour and expectant management in postterm pregnancy: A matched cohort study. Journal of Midwifery & Women’s Health, 54(5), 351–356. https://doi.org/10.1016/j.jmwh.2008.12.011
Huang, Y., Iosif, A. M., Hansen, R. L., & Schmidt, R. J. (2020). Maternal polyunsaturated fatty acids and risk for autism spectrum disorder in the MARBLES high-risk study. Autism, 24(5), 1191–1200. https://doi.org/10.1177/1362361319877792
Idring, S., Magnusson, C., Lundberg, M., Ek, M., Rai, D., Svensson, A. C., Dalman, C., Karlsson, H., & Lee, B. K. (2014). Parental age and the risk of autism spectrum disorders: Findings from a Swedish population-based cohort. International Journal of Epidemiology, 43(1), 107–115. https://doi.org/10.1093/ije/dyt262
Johnson, B., Ulberg, S., Shivale, S., Donaldson, J., Milczarski, B., & Faraone, S. V. (2014). Fibromyalgia, autism, and opioid addiction as natural and induced disorders of the endogenous opioid hormonal system. Discovery Medicine, 18(99), 209–220.
Lai, M. C., & Yang, S. N. (2010). Perinatal hypoxic-ischemic encephalopathy. Journal of Biomedicine and Biotechnology. https://doi.org/10.1155/2011/609813
Lyall, K., Croen, L., Daniels, J., Fallin, M. D., Ladd-Acosta, C., Lee, B. K., Park, B. Y., Snyder, N. W., Schendel, D., Volk, H., Windham, G. C., & Newschaffer, C. (2017). The changing epidemiology of autism spectrum disorders. Annual Review of Public Health, 38, 81–102. https://doi.org/10.1146/annurev-publhealth-031816-044318
Lyall, K., Schmidt, R. J., & Hertz-Picciotto, I. (2014). Maternal lifestyle and environmental risk factors for autism spectrum disorders. International Journal of Epidemiology, 43(2), 443–464. https://doi.org/10.1093/ije/dyt282
Maenner, M. J., Shaw, K. A., Baio, J., Washington, A., Patrick, M., DiRienzo, M., Christensen, D. L., Wiggins, L. D., Pettygrove, S., Andrews, J. G., Lopez, M., Hudson, A., Baroud, T., Schwenk, Y., White, T., Rosenberg, C. R., Lee, L. C., Harrington, R. A., Huston, M., … Dietz, P. M. (2020). Prevalence of autism spectrum disorder among children aged 8 years—Autism and developmental disabilities monitoring network, 11 Sites, United States, 2016. MMWR Surveillance Summaries, 69(4), 1–12. https://doi.org/10.15585/mmwr.ss6904a1.
Matelski, L., & Van de Water, J. (2016). Risk factors in autism: Thinking outside the brain. Journal of Autoimmunity, 67, 1–7. https://doi.org/10.1016/j.jaut.2015.11.003
Matson, J. L., & Kozlowski, A. M. (2011). The increasing prevalence of autism spectrum disorders. Research in Autism Spectrum Disorders, 5(1), 418–425. https://doi.org/10.1016/j.rasd.2010.06.004
May, T., Brignell, A., & Williams, K. (2020). Autism spectrum disorder prevalence in children aged 12–13 years from the longitudinal study of Australian children. Autism Research, 13(5), 821–827. https://doi.org/10.1002/aur.2286
Modabbernia, A., Velthorst, E., & Reichenberg, A. (2017). Environmental risk factors for autism: An evidence-based review of systematic reviews and meta-analyses. Molecular Autism, 8(1), 13. https://doi.org/10.1186/s13229-017-0121-4
Penn, Z., & Ghaem-Maghami, S. (2001). Indications for caesarean section. Best Practice & Research Clinical Obstetrics & Gynaecology, 15(1), 1–15. https://doi.org/10.1053/beog.2000.0146
Qiu, C., Lin, J. C., Shi, J. M., Chow, T., Desai, V. N., Nguyen, V. T., Riewerts, R. J., Feldman, R. K., Segal, S., & Xiang, A. H. (2020). Association between epidural analgesia during labor and risk of autism spectrum disorders in offspring. JAMA Pediatrics, 174(12), 1168–1175. https://doi.org/10.1001/jamapediatrics.2020.3231
Sandin, S., Schendel, D., Magnusson, P., Hultman, C., Surén, P., Susser, E., Grønborg, T., Gissler, M., Gunnes, N., Gross, R., Henning, M., Bresnahan, M., Sourander, A., Hornig, M., Carter, K., Francis, R., Parner, E., Leonard, H., Rosanoff, M., … Reichenberg, A. (2016). Autism risk associated with parental age and with increasing difference in age between the parents. Molecular Psychiatry, 21(5), 693-700.https://doi.org/10.1038/mp.2015.70
Sandin, S., Lichtenstein, P., Kuja-Halkola, R., Hultman, C., Larsson, H., & Reichenberg, A. (2017). The heritability of autism spectrum disorder. JAMA, 318(12), 1182–1184. https://doi.org/10.1001/jama.2017.12141
Savage, S., & Ma, D. (2014). The neurotoxicity of nitrous oxide: The facts and “putative” mechanisms. Brain Sciences, 4(1), 73–90. https://doi.org/10.3390/brainsci4010073
Schmidt, R. J., Hansen, R. L., Hartiala, J., Allayee, H., Schmidt, L. C., Tancredi, D. J., Tassone, F., & Hertz-Picciotto, I. (2011). Prenatal vitamins, one-carbon metabolism gene variants, and risk for autism. Epidemiology (Cambridge, Mass.), 22(4), 476–485. https://doi.org/10.1097/EDE.0b013e31821d0e30
Schmidt, R. J., Tancredi, D. J., Ozonoff, S., Hansen, R. L., Hartiala, J., Allayee, H., Schmidt, L. C., Tassone, F., & Hertz-Picciotto, I. (2012). Maternal periconceptional folic acid intake and risk of autism spectrum disorders and developmental delay in the CHARGE (CHildhood Autism Risks from Genetics and Environment) case-control study. The American Journal of Clinical Nutrition, 96(1), 80–89. https://doi.org/10.3945/ajcn.110.004416
Tseng, P. T., Chen, Y. W., Stubbs, B., Carvalho, A. F., Whiteley, P., Tang, C. H., Yang, W. C., Chen, T. Y., Li, D. J., Chu, C. S., Yang, W. C., Liang, H. Y., Wu, C. K., Yen, C. F., & Lin, P. Y. (2017). Maternal breastfeeding and autism spectrum disorder in children: A systematic review and meta-analysis. Nutritional Neuroscience, 22(5), 354–362. https://doi.org/10.1080/1028415X.2017.1388598
Walker, C. K., Krakowiak, P., Baker, A., Hansen, R. L., Ozonoff, S., & Hertz-Picciotto, I. (2015). Preeclampsia, placental insufficiency, and autism spectrum disorder or developmental delay. JAMA Pediatrics, 169(2), 154–162. https://doi.org/10.1001/jamapediatrics.2014.2645
Wang, C., Geng, H., Liu, W., & Zhang, G. (2017). Prenatal, perinatal, and postnatal factors associated with autism: A meta-analysis. Medicine, 96(18), e6696. https://doi.org/10.1097/MD.0000000000006696
Wang, M., Li, K., Zhao, D., & Li, L. (2017). The association between maternal use of folic acid supplements during pregnancy and risk of autism spectrum disorders in children: A meta-analysis. Molecular Autism, 8(1), 1–4. https://doi.org/10.1186/s13229-017-0170-8
Wang, X., Yang, J., Zhang, H., Yu, J., & Yao, Z. (2019). Oral probiotic administration during pregnancy prevents autism-related behaviors in offspring induced by maternal immune activation via anti-inflammation in mice. Autism Research, 12(4), 576–588. https://doi.org/10.1002/aur.2079
Wu, S., Wu, F., Ding, Y., Hou, J., Bi, J., & Zhang, Z. (2017). Advanced parental age and autism risk in children: A systematic review and meta-analysis. Acta Psychiatrica Scandinavica, 135(1), 29–41. https://doi.org/10.1111/acps.12666
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CMB, DWA, and KS contributed to the project conceptualisation. Data were collected by CMB. AW, JB, MH, and KS contributed to data analyses. All authors contributed to the writing of the manuscript. Data were collected by CMB as part of an earlier study, yet findings based on this dataset have not been previously published. Data analysis and manuscript writing was completed as part of a research scholarship issued to AW by Swinburne University of Technology, who paid her A$1800 for her contribution.
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Ethical approval was granted by Swinburne University Human Research Ethics Committee in accordance with the principles of the Declaration of Helsinki.
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Whitely, A., Shandley, K., Huynh, M. et al. Brief Report: Pregnancy, Birth and Infant Feeding Practices: A Survey-Based Investigation into Risk Factors for Autism Spectrum Disorder. J Autism Dev Disord 52, 5072–5078 (2022). https://doi.org/10.1007/s10803-021-05348-3
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DOI: https://doi.org/10.1007/s10803-021-05348-3