Published August 13, 2013
A new study of North Carolina birth records indicates that pregnant women who undergo induced or augmented labors may have an increased risk for giving birth to a child with autism.
Induced labor refers to the artificial stimulation of childbirth, in which doctors prompt uterine contractions to begin before the onset of spontaneous labor. Labor augmentation involves increasing the strength, duration or frequency of uterine contractions after the start of spontaneous labor.
Using the North Carolina Detailed Birth Record and Educational Research databases, researchers from Duke University Medical Center analyzed records from 625,042 live births. The cohort included 5,500 children who were diagnosed as being autistic.
Compared to the mothers whose births were neither induced nor augmented, mothers who had induced or augmented labor – or a combination of the two – had increased odds of having a child with autism. Among male children, both induced and augmented labor was associated with a 35 percent higher risk of autism. However, only labor augmentation was associated with an increased risk of autism in female babies, while induced labor showed no correlation in females.
This results of this study, published in JAMA Pediatrics, are, in my opinion, highly provocative – especially because of the large size of the study. But as the researchers stated in their conclusions, further research need to be done in this area.
"While these results are interesting, further investigation is needed to differentiate among potential explanations of the association including underlying pregnancy conditions requiring the eventual need to induce/augment, the events of labor and delivery associated with induction/augmentation, and the specific treatments and dosing used to induce/augment labor," the study concluded.
My only problem with this study is that it does not shed light on why the correlation between these types of delivery and the increased risk for autism seems to exist.
In the past, the mode of delivery and the use of oxytocin – a commonly used medication during childbirth – had both been mentioned as potential contributing factors for the development of autism. However, this has never proven, including in this study.
Though they acknowledge it, there are many variables that the authors clearly failed to consider that limit their findings. We know very little about the medical conditions of both the mothers and the children at delivery. We don’t know anything about a possible family history of autism in those studied. We don’t know any information about how the diagnosis was made, including age and criteria used. And we certainly don’t have any information on the length of labor or the amount of medication used during the induction or augmentation phase.
So even though I find this study quite interesting, further analysis needs to be done.
We have to be careful not to incite fear in expectant mothers about induction or augmentation of labor when either practice may be medically necessary to prevent fetal complications. On the other hand, I hope this study will help dissuade doctors and patients from deciding to induce or augment labor electively, without any maternal or fetal risks.