Advances in Neurodevelopmental Disorders

, Volume 2, Issue 2, pp 190–198 | Cite as

Cesarean Section as a Predictor for Autism: a Case-Control Study in Valencia (Spain)

  • Alfredo Perales-Marín
  • Agustín Llópis-González
  • Isabel Peraita-Costa
  • Pablo Cervera-Boada
  • Montserrat Téllez de Meneses
  • Salvador Marí-Bauset
  • María Morales-Suárez-VarelaEmail author


Growing interest has been shown in recent decades in the role of perinatal factors in relation to autistic spectrum disorders (ASD). Several studies have identified that cesarean sections (CS) could be a risk factor for ASD. The objective was to evaluate the relationship between CS and ASD in childhood as an early indicator for ASD diagnosis. This is a hospital-based nested case-control study in a retrospective cohort of births during 1996–2011. Cases were defined as children diagnosed with ASD at the Neuropediatric Unit of the La Fe Hospital in the last 10 years and controls as children without ASD. After pairing controls with cases for children’s date of birth at a 4:1 ratio, 251 mother-child pairs (53 cases, 198 controls) were studied, for whom information about perinatal risk factors, such as mode of delivery (vaginal vs. CS), and potential confounders was collected. Of the children identified, the control group was made up of 100 boys and 98 girls while the case group included 47 boys and 6 girls. A multivariable conditional logistic regression model was built (matched by children’s date of birth) to assess any potential association in relation with ASD diagnosis, where birth by CS presented a cOR = 3.37 (95% CI 1.57–7.25) of ASD. The adjusted model (for maternal age, child’s sex, gravidity, and gestation weeks) suggested a relation between CS and ASD (aOR = 3.36, 95% CI 1.44–7.85). The results suggest that the probability of ASD after a birth by CS is over three times that observed after unassisted vaginal delivery. Large prospective studies are needed to understand if this relationship is a causal pathway or consequence of ASD. The results suggest that using birth by CS as a predictor for ASD by pediatric health professionals in their patient follow-ups may be an appropriate tool that could improve early ASD detection.


Autism spectrum disorder Cesarean section Pregnancy Predictor Case-control studies 



The authors would like to thank Vicente Huerta-Biosca for his help in the data collection phase of this study.

Author Contributions

APM collaborated with the design and execution of the study and the editing of the final manuscript. ALG collaborated with the design of the study, the data analyses, and the editing of the final manuscript. IPC collaborated with the data analyses, the writing and editing of the manuscript. PCB collaborated with the execution of the study and the editing of the final manuscript. MTM collaborated with the execution of the study and the editing of the final manuscript. SMB collaborated with the data analyses, writing, and editing of the final manuscript. MMSV collaborated with the design and execution of the study, the data analyses, and the writing and editing of the final manuscript.


This work has been financed through research project SMI 19/2014 of the Regional Valencian Ministry of Health (Spain).

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The Ethics Committee of the La Fe Hospital provided IRB approval for this study.

Informed Consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Alfredo Perales-Marín
    • 1
    • 2
  • Agustín Llópis-González
    • 3
    • 4
  • Isabel Peraita-Costa
    • 3
  • Pablo Cervera-Boada
    • 5
  • Montserrat Téllez de Meneses
    • 6
  • Salvador Marí-Bauset
    • 3
  • María Morales-Suárez-Varela
    • 3
    • 4
    Email author
  1. 1.Department of ObstetricsLa Fe University Polytechnic HospitalValenciaSpain
  2. 2.Department of Pediatrics, Obstetrics and GynecologyUniversity of ValenciaValenciaSpain
  3. 3.Public Health and Environmental Care Unit, Department of Preventive MedicineUniversity of ValenciaBurjassotSpain
  4. 4.CIBER of Epidemiology and Public Health (CIBERESP)MadridSpain
  5. 5.Department of PsychiatryDr. Peset University HospitalValenciaSpain
  6. 6.Department of NeuropediatricsLa Fe University Polytechnic HospitalValenciaSpain

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