1. Extremely low gestational age and very low birthweight for gestational age are risk factors for autism spectrum disorder in a large cohort study of 10-year-old children born at 23-27 weeks' gestation
- Author
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Susan Dieterich, Gary Stainback, Ryan Martin, Robert M. Joseph, Beth Powers, Jennifer DeRidder, Susan Barron, Diane Warner, Jill Damon-Minow, Scott J. Hunter, Deborah Weiland, Jennifer Benjamin, T. Michael O'Shea, Katarzyna Chawarska, Steven J. Korzeniewski, Janice Bernhardt, Aimee Asgarian, Kelly Vogt, Joni McKeeman, Steve Pastyrnak, Beth Kring, Rachel Wilson, Krissy Washington, Ann Foley, Barbara Prendergast, Molly Wood, Janice Ware, Judith Klarr, Echo Meyer, Janice Wereszczak, Debbie Allred, Sarah Nota, Julie Rathbun, Kirsten McGhee, Richard A. Ehrenkranz, Brandi Henson, Wendy Burdo-Hartman, Jean A. Frazier, Emily Neger, Timothy Heeren, Rugile Ramoskaite, Ellen Waldrep, Michael E. Msall, Madeleine Lenski, Jenifer Walkowiak, Kathryn Mattern, Kathy Tsatsanis, Elaine Romano, Suzanne Wiggins, Sophy Kim, Gail Hounshell, Stephen C. Engelke, Megan Lloyd, Teri Crumb, Karl C.K. Kuban, Patricia Brown, Emily Ansusinha, Patricia Lee, Nancy Darden-Saad, Deborah Hirtz, Elizabeth N. Allred, Lauren Venuti, Taryn Coster, Karen Bearrs, Megan Scott, Ellen C. Perrin, Brian Dessureau, Nancy Peters, Alan Leviton, Anjali Sadhwani, and Jackie Friedman
- Subjects
Male ,Pediatrics ,medicine.medical_specialty ,Autism Spectrum Disorder ,Gestational Age ,Article ,Cohort Studies ,03 medical and health sciences ,0302 clinical medicine ,Pregnancy ,Risk Factors ,030225 pediatrics ,Intellectual Disability ,mental disorders ,Intellectual disability ,medicine ,Humans ,Infant, Very Low Birth Weight ,Prospective Studies ,Child ,business.industry ,Infant, Newborn ,Obstetrics and Gynecology ,Gestational age ,Odds ratio ,medicine.disease ,Autism spectrum disorder ,Infant, Small for Gestational Age ,Small for gestational age ,Autism ,Female ,business ,030217 neurology & neurosurgery ,Cohort study ,Follow-Up Studies - Abstract
No prospective cohort study of high-risk children has used rigorous exposure assessment and optimal diagnostic procedures to examine the perinatal antecedents of autism spectrum disorder separately among those with and without cognitive impairment.We sought to identify perinatal factors associated with increased risk for autism spectrum disorder with and without intellectual disability (intelligence quotient70) in children born extremely preterm.This prospective multicenter (14 institutions in 5 states) birth cohort study included children born at 23-27 weeks' gestation in 2002 through 2004 who were evaluated for autism spectrum disorder and intellectual disability at age 10 years. Pregnancy information was obtained from medical records and by structured maternal interview. Cervical-vaginal "infection" refers to maternal report of bacterial infection (n = 4), bacterial vaginosis (n = 30), yeast infection (n = 62), mixed infection (n = 4), or other/unspecified infection (n = 43; eg, chlamydia, trichomonas, or herpes). We do not know the extent to which infection per se was confirmed by microbial colonization. We use the terms "fetal growth restriction" and "small for gestational age" interchangeably in light of the ongoing challenge to discern pathologically from constitutionally small newborns. Severe fetal growth restriction was defined as a birthweight Z-score for gestational age at delivery-2 (ie, ≥2 SD below the median birthweight in a referent sample that excluded pregnancies delivered for preeclampsia or fetal indications). Participants were classified into 4 groups based on whether or not they met rigorous diagnostic criteria for autism spectrum disorder and intellectual disability (autism spectrum disorder+/intellectual disability-, autism spectrum disorder+/intellectual disability+, autism spectrum disorder-/intellectual disability+, and autism spectrum disorder-/intellectual disability-). Temporally ordered multinomial logistic regression models were used to examine the information conveyed by perinatal factors about increased risk for autism spectrum disorder and/or intellectual disability (autism spectrum disorder+/intellectual disability-, autism spectrum disorder+/intellectual disability+, and autism spectrum disorder-/intellectual disability+).In all, 889 of 966 (92%) children recruited were assessed at age 10 years, of whom 857 (96%) were assessed for autism spectrum disorder; of these, 840 (98%) children were assessed for intellectual disability. Autism spectrum disorder+/intellectual disability- was diagnosed in 3.2% (27/840), autism spectrum disorder+/intellectual disability+ in 3.8% (32/840), and autism spectrum disorder-/intellectual disability+ in 8.5% (71/840). Maternal report of presumed cervical-vaginal infection during pregnancy was associated with increased risk of autism spectrum disorder+/intellectual disability+ (odds ratio, 2.7; 95% confidence interval, 1.2-6.4). The lowest gestational age category (23-24 weeks) was associated with increased risk of autism spectrum disorder+/intellectual disability+ (odds ratio, 2.9; 95% confidence interval, 1.3-6.6) and autism spectrum disorder+/intellectual disability- (odds ratio, 4.4; 95% confidence interval, 1.7-11). Severe fetal growth restriction was strongly associated with increased risk for autism spectrum disorder+/intellectual disability- (odds ratio, 9.9; 95% confidence interval, 3.3-30), whereas peripartum maternal fever was uniquely associated with increased risk of autism spectrum disorder-/intellectual disability+ (odds ratio, 2.9; 95% confidence interval, 1.2-6.7).Our study confirms that low gestational age is associated with increased risk for autism spectrum disorder irrespective of intellectual ability, whereas severe fetal growth restriction is strongly associated with autism spectrum disorder without intellectual disability. Maternal report of cervical-vaginal infection is associated with increased risk of autism spectrum disorder with intellectual disability, and peripartum maternal fever is associated with increased risk for intellectual disability without autism spectrum disorder.
- Published
- 2016