Induction of labor does not hike the risk for Autism Spectrum disorders.

Clinical Pearls:

• Contrary to the findings of earlier study, Induction of labor does not increase the risk for development of Autism Spectrum disorders(ASD).

Autism Spectrum disorders(ASD) is a group of complex developmental disability that affects a person ability to interact and communicate socially. It includes several conditions that were earlier diagnosed separately and include autistic disorder, pervasive developmental disorder not otherwise specified (PDD-NOS), and Asperger syndrome.

According to CDC about 1% of world population have ASD. It is the fastest growing developmental disability in US and the current prevalence is 1 in 64 births and has increased 119.4 percent from 2000 (1 in 150) to 2010 (1 in 68).[1] An article published in JAMA Pediatric 2014 by Buescher et al. estimated that about 3.5 million people in US live with ASD.[2]

Numerous pregnancy related risk factors have been attributed in putting the children at high risk for ASD like children that were born to older parents,  were preterm or low birth weight, born with other chromosomal disorders like  Down syndrome, fragile X syndrome, tuberous sclerosis and  those delivered by cesarean section.

A study published in Annals of Epidemiology attributed three perinatal risk factors like being born too early, too small, and/or by Cesarean delivery to be responsible for 12-13% of ASD in children.[3]

Many other studies have examined the mother’s use of  serotonin uptake  inhibitors (SSRIs) and increasing use of ART as a causative factor for  sudden increase in prevalence of ASD.

Another large population based study published in JAMA pediatrics in October,2013 concluded that “Compared with children born to mothers who received neither labor induction nor augmentation, children born to mothers who were induced and augmented, induced only, or augmented only experienced increased odds of autism after controlling for potential confounders related to socioeconomic status, maternal health, pregnancy-related events and conditions, and birth year. The observed associations between labor induction/augmentation were particularly pronounced in male children.”[4]

This study sparked a widespread debate between physicians and researchers and the lead author of the study Dr. Gregory proposed the culprit to be oxytocin in induced or augmented labors, putting these children at high risk for ASD. After this controversy ACOG put out a committee opinion (597) in 2014 stating that “Current evidence does not support a conclusion that labor induction or augmentation causes autism spectrum disorder (ASD) in newborns, available evidence is inconsistent and does not demonstrate causation.”[5]

A recent study conducted by researchers at Harvard T.H. Chan School of public health in Boston and published in JAMA pediatrics online first on July 25, 2016 found no association between induction of labor and ASD. This large nationwide study performed in Sweden, followed up a cohort of 1,362,950 children born between 1992-2005. Out of which 1.6% (22077) children were diagnosed with ASD by ages 8 years through 21 years.  

In 11% of the mothers’ labor induction was done due to preeclampsia, gestational diabetes and chronic hypertension. After the statistical analysis, the study found an association between labor induction and ASD but when the analysis was performed between siblings and close relatives the association was not documented.

Siblings share many genetic, socioeconomic and maternal characteristics that may increase the risk for development of ASD, so if association is not documented when comparing with them, the association probably does not exist.

The finding of this large study suggests that if clinically indicated, decision to induce labor should not be withheld in fear of baby developing ASD. Not to induce the labor when indicated may have adverse neonatal consequences.

Dr. Bateman concludes "Overall, these findings should provide reassurance to women who are about to give birth, that having their labor induced will not increase their child's risk of developing autism spectrum disorders."

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[1] https://www.cdc.gov/ncbddd/autism/facts.html

[2] http://www.ncbi.nlm.nih.gov/pubmed/24911948

[3] Schieve LA, Tian LH, Baio J, Rankin K, Rosenberg D, Wiggins L, Maenner MJ, Yeargin-Allsopp M, Durkin M, Rice C, King L, Kirby RS, Wingate MS, Devine O. Annals of Epidemiology. January 2014. [epub ahead of print]

[4] Gregory SG, Anthopolos R, Osgood CE, Grotegut CA, Miranda M. Association of Autism With Induced or Augmented Childbirth in North Carolina Birth Record (1990-1998) and Education Research (1997-2007) Databases. JAMA Pediatr.2013;167(10):959-966. doi:10.1001/jamapediatrics.2013.2904.

[5] http://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Labor-Induction-or-Augmentation-and-Autism