TY - JOUR
T1 - Autism spectrum disorder and obstetric optimality
T2 - a twin study and meta-analysis of sibling studies
AU - Gómez-Vallejo, Sandra
AU - Leoni, Marguerite
AU - Ronald, Angelica
AU - Colvert, Emma
AU - Happé, Francesca
AU - Bolton, Patrick
N1 - Funding Information:
S.G.V. was supported by a grant from Alicia Koplowitz Foundation. We gratefully acknowledge the ongoing contribution of the participants in the Twins Early Development Study (TEDS) and their families. TEDS is supported by a program grant from the UK Medical Research Council (MR/V012878/1 and previously MR/M021475/1), with additional support from the US National Institutes of Health (AG046938). The authors have declared that they have no competing or potential conflicts of interest. Key points
Funding Information:
S.G.V. was supported by a grant from Alicia Koplowitz Foundation. The authors gratefully acknowledge the ongoing contribution of the participants in the Twins Early Development Study (TEDS) and their families.?TEDS is supported by a program grant from the UK Medical Research Council (MR/V012878/1 and previously?MR/M021475/1),?with additional support from the US National Institutes of Health (AG046938). The authors have declared that they have no competing or potential conflicts of interest.Key points Research has shown ASD is influenced by environmental factors, although it is unclear which factors play a role. In meta-analyses of sibling studies we identified maternal hypertension, uterine bleeding and exposure to antibiotic as factors that increase risk of ASD, although the influence is small. In our study we observed that children with ASD do not present more obstetrical complications than their unaffected twins. Therefore, we concluded that the increased number of obstetric complications in autistic children is the result of shared familial liability for obstetric complications and ASD. Research has shown ASD is influenced by environmental factors, although it is unclear which factors play a role. In meta-analyses of sibling studies we identified maternal hypertension, uterine bleeding and exposure to antibiotic as factors that increase risk of ASD, although the influence is small. In our study we observed that children with ASD do not present more obstetrical complications than their unaffected twins. Therefore, we concluded that the increased number of obstetric complications in autistic children is the result of shared familial liability for obstetric complications and ASD.
Publisher Copyright:
© 2021 Association for Child and Adolescent Mental Health.
PY - 2021/11
Y1 - 2021/11
N2 - Background: Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder with a strong genetic basis. Recent studies have suggested that its aetiology is also influenced by environmental factors. Some of the most examined environmental factors are obstetric complications. However, the results are inconsistent. Methods: We aimed to explore the association between obstetric complications and autism in a population-based twin sample using the Obstetric Enquiry Scale (OES), a scale that measures the presence or absence of pre-, peri- and neonatal factors. Additionally, we report the meta-analytic results for obstetrical factors reported in previously published sibling studies. Results: Our study included 115 cases pairs and 62 controls pairs and showed that children with autism and their unaffected co-twins present significantly more obstetric complications than controls (ASD vs. controls β 1.26, CI 95% 1.11–1.40 p <.001; unaffected co-twin vs. controls β 1.20, 95% CI 1.07–1.36 p <.003). However, we did not find statistically significant differences between children with ASD and their unaffected co-twins (β.96, 95% CI 0.85–1.09, p 0.55). Meta-analysis demonstrated that maternal hypertension (RR 1.35, CI 95% 1.23–1.48), uterine bleeding (RR 1.20 CI 95% 1.01–1.42) and exposure to antibiotic during pregnancy (1.11 CI 95% 1.00–1.22) increase risk of ASD. Conclusions: This study confirms that children with ASD and their unaffected twins show more obstetric complications than controls. However, these complications do not distinguish between ASD twins and their unaffected co-twins. In addition, the meta-analysis showed little influence of birth factors on ASD which suggests a shared familial liability for both obstetric complications and autism, rather than a causal association.
AB - Background: Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder with a strong genetic basis. Recent studies have suggested that its aetiology is also influenced by environmental factors. Some of the most examined environmental factors are obstetric complications. However, the results are inconsistent. Methods: We aimed to explore the association between obstetric complications and autism in a population-based twin sample using the Obstetric Enquiry Scale (OES), a scale that measures the presence or absence of pre-, peri- and neonatal factors. Additionally, we report the meta-analytic results for obstetrical factors reported in previously published sibling studies. Results: Our study included 115 cases pairs and 62 controls pairs and showed that children with autism and their unaffected co-twins present significantly more obstetric complications than controls (ASD vs. controls β 1.26, CI 95% 1.11–1.40 p <.001; unaffected co-twin vs. controls β 1.20, 95% CI 1.07–1.36 p <.003). However, we did not find statistically significant differences between children with ASD and their unaffected co-twins (β.96, 95% CI 0.85–1.09, p 0.55). Meta-analysis demonstrated that maternal hypertension (RR 1.35, CI 95% 1.23–1.48), uterine bleeding (RR 1.20 CI 95% 1.01–1.42) and exposure to antibiotic during pregnancy (1.11 CI 95% 1.00–1.22) increase risk of ASD. Conclusions: This study confirms that children with ASD and their unaffected twins show more obstetric complications than controls. However, these complications do not distinguish between ASD twins and their unaffected co-twins. In addition, the meta-analysis showed little influence of birth factors on ASD which suggests a shared familial liability for both obstetric complications and autism, rather than a causal association.
KW - Autism spectrum disorder
KW - genetics
KW - obstetric complications
UR - http://www.scopus.com/inward/record.url?scp=85116224964&partnerID=8YFLogxK
U2 - 10.1111/jcpp.13526
DO - 10.1111/jcpp.13526
M3 - Article
AN - SCOPUS:85116224964
SN - 0021-9630
VL - 62
SP - 1353
EP - 1362
JO - Journal of Child Psychology and Psychiatry and Allied Disciplines
JF - Journal of Child Psychology and Psychiatry and Allied Disciplines
IS - 11
ER -
