AutismPerinataltxt

Evidence of perinatal complications associated with autism

van Handel M, Swaab H, de Vries LS, Jongmans MJ.Long-term cognitive and

behavioral

consequences of neonatal encephalopathy following perinatal

asphyxia:

a review.

Eur J

Pediatr. 2007 Apr 11; [Epub ahead of print].

"Most outcome studies have focused on neurological

functioning and

severe

deficits in

young children (<4 years).

In general, very few

children

with mild

encephalopathy

show

neurological impairments or

have

developed severe

mental or motor retardation at

preschool age. ...

Only a

few studies looked at the

behavioral consequences

of NE.

Those

studies

found elevated rates of

hyperactivity

and autism in children with

moderate

NE."

2. Kolevzon A, Gross R, Reichenberg A.Prenatal and perinatal risk factors for

autism: a

review and integration of findings.

Arch Pediatr Adolesc Med. 2007 Apr;

161(4):326-33.

"According to our review, 3 parental characteristics and

2 obstetric

conditions

emerge

as potential risk factors for

autism: namely, paternal

age, maternal age,

maternal

immigration,

growth restriction, and

newborn

hypoxia. In

analyses that

adjusted for

confounding variables,

these

factors

usually remained statistically

significant."

Maimburg RD, Vaeth M. Perinatal risk factors and infantile autism. Acta

Psychiatr Scand.

2006

Oct;114(4):257-64.

We also found strong associations between children with infantile

autism and

mothers with

foreign citizenship, children with congenital

malformations and

children

who needed

treatment at Neonatal Intensive

Care Unit (NICU) after birth.

When the

caesarean sections

were

categorized into scheduled and unscheduled

procedures, we

found only

scheduled

caesarean sections to be associated with

infantile autism.

. Badawi N et al. Autism following a history of newborn encephalopathy: more

than a

coincidence? Dev Med Child Neurol. 2006 Feb;48(2):85-9.

"... in a population-based study of moderate and severe term newborn

encephalopathy

(NE) in

Western Australia ...infants with NE were 5.9

(95%

CI 2.0–

16.9)

times more likely

to be

diagnosed with an ASD than controls...

this was not

an expected association at the

outset of

the study"

. Larsson HJ et al. Risk factors for autism: perinatal factors, parental psychiatric

history,

and

socioeconomic status. Am J Epidemiol. 2005;161:916-25.

"In the unadjusted analyses, breech presentation, lowApgar score (less

than or

equal 7)

at 5

minutes, low birth weight (less than or equal 2,500

g),

gestational age

at birth of

less than 35

weeks, and being small for

gestational age were

associated with a

statistically significantly

increased

risk of autism..."

Gillberg C, Cederlund M. Asperger syndrome: familial and pre- and perinatal

factors. J

Autism Dev Disord. 2005 Apr;35(2):159-66.

"Five children had had an Apgar score of 6 or

under at 1, 5 , or 10

minutes,

and 3

these had

scores of 1 or 2 (i.e., they had severe

postnatal

asphyxia).

... Of the

100

individuals, 58 had one or more

remarks in their

birth- or perinatal records

about a

serious problem in

the peri-/neonatal

period.

Cederlund M, Gillberg C. One hundred males with Asperger syndrome: a

clinical study

of background and associated factors.

Dev Med Child Neurol. 2004

Oct;46(10):652-60.

For 58 of 99 children, some kind of abnormality was noted in

their

neonatal

record. ...

Twenty-two had had hyperbilirubinemia (plasma

bilirubin more

than

200μmol/l), ...

Hyperbilirubinemia occurs in about 10%

of newborn

infants...

Forty-

five of 92 children

(49%) for whom fairly

detailed

data about

early language

development were available,

clearly

did not have normal

language development

at 2 years of

age. It cannot

concluded that the

remainder had normal

language

development.

Glasson EJ

et al

. Perinatal factors and the development of autism: a

population

study.

Arch Gen Psychiatry. 2004 Jun;61(6):618-27.

"Cases were more likely to have experienced fetal distress during labor

(OR, 1.64;

95%

CI, 1.15-2.34)

. Apgar scores calculated at 1 minute showed

that significantly

more

cases achieved a score of 6 or less

(54 [19.5%] of

277 cases with data recorded

nce

1991

..."

[12.9%] of 512 control subjects with data recorded since 1991)(OR, 1.6; 95% CI,

1.1-2.4),

and cases were more likely to have taken more than 1 minute

before the onset of

spontaneous respiration

(OR, 1.4; 95% CI, 1.0-1.9)

Wilkerson DS

et al

. Perinatal complications as predictors of infantile autism.

Int

Neurosci. 2002 Sep;112(9):1085-98.

"… 5 items were found to significantly predict group membership

(prescriptions

taken

during pregnancy, length of labor, viral infection,

abnormal presentation at

delivery,

and

low birth weight)."

Hultman CM

et al

. Perinatal risk factors for infantile autism. Epidemiology.

2002 Jul;13

(4):

417-23.

"The

risk of autism

was associated with daily smoking in early pregnancy (OR =

1.4; CI =

1.1-1.8), maternal birth outside Europe and North America (OR = 3.0; CI

1.7-5.2),

cesarean delivery (OR = 1.6; CI = 1.1-2.3), being small for gestational

age (SGA; OR = 2.1;

CI = 1.1-3.9), a

5-minute Apgar score below 7

(OR = 3.2,

CI = 1.2-8.2), and congenital

malformations (OR = 1.8, CI = 1.1-3.1)."

Note: The

OR (odds ratio) was greatest for 5-

min

Apgar score below 7.

Zwaigenbaum L

et al

. Pregnancy and birth complications in autism and

liability

to the

broader autism phenotype. J Am Acad Child Adolesc Psychiatry

2002 May;

41(5):572-9

"Children with autism spectrum disorders have lower optimality (higher

rates of

complications) than unaffected siblings…"

. Greenberg DA

et al

. Excess of twins among affected sibling pairs with autism:

implications for the etiology of autism. Am J Hum Genet 2001 Nov;69(5):1062-7

"In a sample of families selected because each had exactly two affected

sibs, we

observed a remarkably high proportion of affected twin pairs,

both MZ and DZ…"

. Bodier C

et al

. Autisme et pathologies associées. Étude clinique de 295 cas

troubles

envahissants du developpment. [Autism and associated pathologies.

Clinical

study

of 295

cases involving development disorders] Presse Médicale

2001 Sep 1; 30(24

Pt 1):

1199-

203. French.

"Among the children with a serious medical condition, 34.4% also had

ante-

perinatal

antecedents. Among the 33% without any medical

factor, 77%

also had

ante-

or perinatal

antecedents."

Juul-Dam N

et al

. Prenatal, perinatal, and neonatal factors in autism,

pervasive

developmental disorder-not otherwise specified, and the general

population.

Pediatrics.

2001 Apr;107(4):E63.

"… specific complications that carried the highest risk of autism and PDD-

NOS

represented various forms of pathologic processes with no

presently

apparent

unifying

feature."

Matsuishi T

et al

. Brief report: incidence of and risk factors for autistic

disorder

neonatal intensive care unit survivors. J Autism Dev Disord. 1999

Apr;29(2):

161-6

AD was identified in 18 of the 5,271 children

and the incidence was 34 per

10,000

(0.34%). This value was more than twice the highest prevalence value

previously reported

in Japan.

Children with AD had a significantly higher

history of the meconium

aspiration

syndrome

(p = .0010) than the controls.

Autistic patients had different risk

factors than CP."

Note: CP (cerebral palsy)

occurred in 57 of the 5,271 children.

. Bolton PF

et al

. Obstetric complications in autism: consequences or causes of

the

condition? J Am Acad Child Adolesc Psychiatry. 1997 Feb;36(2):272-81

"…[obstetric] optimality score (OS), were compared in two groups: 78 families

containing

autistic proband (ICD-10 criteria) and 27 families containing a down

syndrome (DS)

proband… RESULTS:

Autistic and DS probands had a

significantly elevated OS

compared with unaffected siblings

, regardless of

birth order position. The elevation

was

mainly due to an increase in mild as

opposed to severe obstetric adversities.

. Ghaziuddin M

et al

. Obstetric factors in Asperger syndrome: comparison with

high-

functioning autism. J Intellect Disabil Res. 1995 Dec;39 ( Pt 6):538-43.

"Males with AS showed a trend toward lower Apgar scores at one minute

…"

. Lord C

et al

. Pre- and perinatal factors in high-functioning females and males

with

autism. J Autism Dev Disord. 1991 Jun;21(2):197-209.

"These data provide slight support for the contribution of nonspecific

pre-

and

perinatal

factors to other etiological bases of autism."

. Steffenburg S

et al

. A twin study of autism in Denmark, Finland, Iceland,

Norway and

Sweden. J Child Psychol Psychiatry. 1989 May;30(3):405-16.

In most of the pairs discordant for autism, the autistic twin had more

perinatal

stress.

. Levy S

et al

. A comparison of obstetrical records of autistic and nonautistic

referrals

for

psychoeducational evaluations. J Autism Dev Disord. 1988 Dec;18

(4):

573-81.

"Abnormal presentation at birth is the only factor that occurred more

frequently

for

the

autistic sample…"

. Lobascher ME

et al

. Childhood autism: an investigation of aetiological factors

twenty-

five cases. Br J Psychiatry. 1970 Nov;117(540):525-9.

"There were more complications of labour in the experimental group

than

the

controls

(p=0.001)

...Abnormal conditions of the child noted at

delivery

occurred

significantly

more frequently in the experimental

group, e.g.

difficulty with

resuscitation, cord around

neck, fractured

skull, cyanosis,

head moulding,

bruising, jaundice

(p<0.0004).