No Link Between Labor Induction and Autism, New Study Says

New findings suggest that there is no association between labor induction and prevalence of autism spectrum disorder (ASD) in offspring, despite previous results to the contrary. Results from the nationwide sample study were published in JAMA Pediatrics.

While previous research has proposed an association between induced or augmented labor and offspring neurodevelopment, results have been inconsistent. Due to the importance and influence this information has on clinicians and potential parents, researchers led by Anna Sara Oberg, PhD, of the Harvard T.H. Chan School of Public Health in Boston, MA, utilized 3 large Swedish population registers to characterize risk of ASD in induced or augmented labor.

The cohort included 1,362,950 live births, of which 22,077 were diagnosed with ASD. Overall, 11% of live births between 1992 and 2005 were induced. Induction was associated with several pregnancy complications, including gestational diabetes, gestational hypertension, and preeclampsia. Notably, 23% of all induced pregnancies were postterm (≥42weeks of gestation), 15% were diagnosed with preeclampsia, and 7% had intrauterine growth restriction.

Labor induction was found to be statistically significantly associated with ASD in the full cohort ([HR], 1.32; 95%

CI, 1.27-1.38), and after adjustment for maternal and birth-specific characteristics (HR, 1.19; 95%CI, 1.13-1.24). However, when discordant siblings were compared to each other to account for all shared genetic and environmental factors, labor induction was no longer associated with ASD (HR, 0.99; 95% CI, 0.88-1.10). This remained true after controlling for later-born cohorts and participants with 1 or more siblings.

“Our findings suggest that concern about ASD after induced labor should not factor into the clinical decision about whether to induce labor,” the authors wrote. “The results also provide reassurance to parturients, that undergoing this common obstetrical intervention will not increase their child’s risk of developing this condition.”

Noting that the results of the current study stand in stark contrast to results from previous studies, Daniel L. Coury, MD, of Nationwide Children’s Hospital and Ohio State University, suggests that we need to present this information in more clear terms to potential parents so as to not further cloud judgment during what is already a time of heightened fear and awareness.

Calling for more loose interpretations of study results, Dr Coury suggests that “Perhaps the release of new research findings could be accompanied by more interpretation of the effect in lay terms. This type of presentation might allow families to make more reasoned decisions regarding their health choices,” he said.

As for clinicians, “It might also be helpful to have medical professionals exercise restraint in their embracing of each new study,” he wrote. “It is true that some research findings are very clear, impressive, and warrant prompt action, but most do not fit in this category and add only incrementally to our overall knowledge. As with many medical conditions, monitoring the situation and exercising reasoned judgment will serve our patients best,” he concluded.

Disclosures: Dr Coury reports support from Autism Speaks, as well as grants from Stemina and SynapDx and consultant fees from Neuren, Cognoa, and AMO-Pharma.

References

1. Oberg AS, D’Onofrio BM, Rickert ME, et al. Association of Labor Induction With Offspring Risk of Autism Spectrum Disorders. JAMA Pediatr. 2016; doi:10.1001/jamapediatrics.2016.0965.
2. Coury DL. What Are the Facts About Autism Spectrum Disorders, Selective Serotonin Reuptake Inhibitors, and Assisted Reproductive Technology? JAMA Pediatr. 2016; doi:10.1001/jamapediatrics.2016.1444.