Pre- and perinatal factors in high-functioning females and males with autism

Lord, Catherine; Mulloy, Catherine; Wendelboe, Michael; Schopler, Eric

doi:10.1007/bf02284760

Cited by 108 publications

(72 citation statements)

References 23 publications

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“…Confounding by birth order has been suggested because prenatal, perinatal, and neonatal complications are more often observed in first-, fourth-, and later-born offspring, and an increased risk of autism has been reported among those who are born first, fourth, and later. 50,71 Although some studies have shown that associations were attenuated and no longer significant after adjusting for parity, 39,59 other studies 50,71 have shown that the positive relationship persists.…”

Section: Resultsmentioning

confidence: 99%

Perinatal and Neonatal Risk Factors for Autism: A Comprehensive Meta-Analysis

2011

PEDIATRICS

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WHAT'S KNOWN ON THIS SUBJECT:Autism etiology is unknown, although perinatal and neonatal exposures have been the focus of epidemiologic research for more than 40 years. Although studies show that obstetrical and neonatal complications may increase autism risk, the specific complications and magnitude of effect have been inconsistent. WHAT THIS STUDY ADDS: OBJECTIVE:To provide the first review and meta-analysis of the association between perinatal and neonatal factors and autism risk. METHODS:PubMed, Embase, and PsycInfo databases were searched for studies that examined the association between perinatal and neonatal factors and autism through March 2007. Forty studies were eligible for the meta-analysis. For each exposure, a summary effect estimate was calculated using a random-effects model. Heterogeneity in effect estimates across studies was examined, and, if found, a metaregression was conducted to identify measured methodological factors that could explain between-study variability. RESULTS:Over 60 perinatal and neonatal factors were examined. Factors associated with autism risk in the meta-analysis were abnormal presentation, umbilical-cord complications, fetal distress, birth injury or trauma, multiple birth, maternal hemorrhage, summer birth, low birth weight, small for gestational age, congenital malformation, low 5-minute Apgar score, feeding difficulties, meconium aspiration, neonatal anemia, ABO or Rh incompatibility, and hyperbilirubinemia. Factors not associated with autism risk included anesthesia, assisted vaginal delivery, postterm birth, high birth weight, and head circumference. CONCLUSIONS:There is insufficient evidence to implicate any 1 perinatal or neonatal factor in autism etiology, although there is some evidence to suggest that exposure to a broad class of conditions reflecting general compromises to perinatal and neonatal health may increase the risk. Methodological variations were likely sources of heterogeneity of risk factor effects across studies. Pediatrics 2011;128: 344-355

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Section: Resultsmentioning

confidence: 99%

Perinatal and Neonatal Risk Factors for Autism: A Comprehensive Meta-Analysis

2011

PEDIATRICS

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“…Although several studies reported no association, [16][17][18]20,22 a few suggested that hyperbilirubinemia occurred more frequently than expected among children later diagnosed with autism. JuulDam et al 15 reported significant associations of PDD- by guest on May 9, 2018 http://pediatrics.aappublications.org/ Downloaded from NOS (n ϭ 13) and autism (n ϭ 51) with hyperbilirubinemia.…”

Section: Discussionmentioning

confidence: 96%

“…Several studies examined the relationship between autism and various obstetric and neonatal complications previously associated with fetal neurologic impairment, including neonatal jaundice, [15][16][17][18][19][20][21][22] and a few reported positive associations. 15,21 The results of those studies have been difficult to interpret, however, because of limitations in study design, including non-population-based study samples, small sample sizes, inadequate comparison groups, reliance on parental reports of jaundice rather than documentation in medical records, and lack of control for potential confounding factors in statistical analyses.…”

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confidence: 99%

Neonatal Hyperbilirubinemia and Risk of Autism Spectrum Disorders

et al. 2005

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ABSTRACT. Objective. To investigate the association between neonatal hyperbilirubinemia and autism spectrum disorders (ASD).Methods. We conducted a large case-control study nested within the cohort of singleton term infants born between 1995 and 1998 at a northern California Kaiser Permanente hospital. Case subjects (n ‫؍‬ 338) were children with an ASD diagnosis recorded in Kaiser Permanente outpatient databases; control subjects (n ‫؍‬ 1817) were children without an ASD diagnosis, who were randomly sampled and frequency-matched to case subjects according to gender, birth year, and birth hospital.Results. Approximately 28% of case and control subjects received >1 bilirubin test in the first 30 days of life. No case-control differences were observed for maximal bilirubin levels of >15 mg/dL (10.1% vs 12.1%), >20 mg/dL (2.1% vs 2.5%), or >25 mg/dL (0.3% vs 0.2%). Compared with children whose maximal neonatal bilirubin levels were <15 mg/dL or not measured, children with any degree of bilirubin level elevation were not at increased risk of ASD, after adjustment for gender, birth facility, maternal age, maternal race/ethnicity, maternal education, and gestational age (for bilirubin levels of 15-19.9 mg/dL: odds ratio: 0.7; 95% confidence interval: 0.5-1.2; for bilirubin levels of 20-24.9 mg/dL: odds ratio: 0.7; 95% confidence interval: 0.3-1.6; for bilirubin levels of >25 mg/dL: odds ratio: 1.1; 95% confidence interval: 0.1-11.2).Conclusion. These data suggest that neonatal hyperbilirubinemia is not a risk factor for ASD. ABBREVIATIONS. PDD-NOS, pervasive developmental disorder not otherwise specified; ASD, autism spectrum disorders; KP, Kaiser Permanente; ICD-9-CM, International Classification of Diseases, 9th Revision, Clinical Modification. A utism is a behaviorally defined, neurodevelopmental disorder characterized by impairments in social interaction, abnormalities in verbal and nonverbal communication, and restricted stereotyped interests and behaviors. 1 Although the causes of autism are not well understood, both genetic and nongenetic factors are thought to play roles. 2,3 Evidence from neuroimaging, neuropathologic, and epidemiologic studies provides support for the concept that aberrant brain development in the prenatal and early postnatal periods underlies the pathogenesis of autism. The most consistently reported neuropathologic findings include decreased numbers of Purkinje cells in the cerebellum, increased cell packing density and smaller neuronal size in the limbic system, and features of cortical dysgenesis or migration disturbances. 4 Although neonatal jaundice is generally benign, very high neonatal bilirubin levels can cause kernicterus and somewhat lower levels were associated with more subtle sequelae in some studies. [5][6][7][8][9][10][11] The most well-established toxic effects of bilirubin on the central nervous system involve the basal ganglia and auditory nuclei. Cognitive function is generally relatively spared, even among children with kernicterus. To our knowledge, deficits in soci...

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“…Where it has been studied carefully, little or no correlation has been found between perinatal risk factors and autism. 19,[24][25][26][27][28][29] …”

Section: Isabelle Rapin MD Bronx Nymentioning

confidence: 99%

Visual field constriction in children treated with vigabatrin

Wilkins¹

2000

Neurology

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Pre- and perinatal factors in high-functioning females and males with autism

Cited by 108 publications

References 23 publications

Perinatal and Neonatal Risk Factors for Autism: A Comprehensive Meta-Analysis

Perinatal and Neonatal Risk Factors for Autism: A Comprehensive Meta-Analysis

Neonatal Hyperbilirubinemia and Risk of Autism Spectrum Disorders

Visual field constriction in children treated with vigabatrin

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