Is cesarean section delivery associated with autism spectrum disorder?

Abstract

Objectives: To investigate a correlation between birth by caesarean section and autism spectrum disorder (ASD). Methods: A case-control study with a case to control ratio of 1:2 was performed in Al-Madina Al-Munawarah city, Kingdom of Saudi Arabia during the year 2016. The cases were selected according to the eligibility criteria and children attending a wellbaby clinic in the same hospital, were chosen as the control group subjects. Data was collected from the medical records and an interview-based questionnaire was administered to the mothers. The chi-square test was used for bivariate analysis and logistic regression to estimate the crude and adjusted odds ratios (ORs). Original Articles Results: Eighty-seven cases of ASD and 174 control group subjects were included in the current study. Approximately 39% (n=34) of the 87 children with ASD were delivered by cesarean section compared to 21% (n=36) of the 174 children in the control group. After adjusting for potentially confounding factors, the adjusted OR was 2.9 (95% confidence interval [CI]: 1.57-5.35). Conclusion: An association between delivery by cesarean section and ASD was found in this study, in support of the findings of other studies. It is recommended that preventive measures are adopted to avoid unnecessary cesarean sections.

Mode of delivery, order of birth, parental age gap and autism spectrum disorder among Malaysian children: A case-control study

“…Findings in our study showed an association between autism and mode of delivery, the odds of autism is higher among those born via Csection compared to those born via normal deliveries. Our results concur with the findings from the study conducted by Al-Zalabani et al (2019), in which the OR value was reported to be 2.9, after adjusting for potential confounders. This finding is similar to the results reported in the systematic review by Curran et al (2015).…”

“…Although the causal relationship between the type of obstetric delivery and ASD is not established, there is some evidence of association between the two. It has been observed that Caesarean section tend to increase the risk of ASD ( Al-Zalabani et al., 2019 ; Curran et al., 2015 , 2016 ; Gregory et al., 2013 ).…”

Anesthesia, sex and miscarriage history may influence the association between cesarean delivery and autism spectrum disorder

“…According to this study, delivery by CS was associated with a higher risk of ASD in children, even after adjusting the potential confounding factors. The result was supported by previous well-established observations that increased risk of ASD was associated with delivery by CS [13,27,29]. Further sex stratification analysis revealed a sex-biased ratio in the risk of developing ASD among births by CS, irrespective of the different surgical indications and method of anesthesia.…”

“…A recent metaanalysis demonstrated that a 23% increase in the risk of ASD was associated with CS compared to vaginal delivery [10]. Even though previous studies have reported that CS is not a risk factor for ASD [11,12], most studies have reached a consistent conclusion [13,14]. The incidence of CS is increasing globally, with an evaluated annual increase of 4% [15].…”

Maternal Mid-Gestation Cytokine Dysregulation in Mothers of Children with Autism Spectrum Disorder

“…A large percentage of cases were delivered via Caesarean section. This may skew results as this mode of delivery has previously been associated with increased ASD incidence (Al-Zalabani et al, 2019 ; Curran et al, 2015a , 2015b ; Morais et al, 2020 ). Larger, longer-term studies, which take long-term outcomes into account will be required with repeated maternal cytokine profiling to attempt to replicate and expand our findings.…”