Have secular changes in perinatal risk factors contributed to the recent autism prevalence increase? Development and application of a mathematical assessment model
Open accessAbstract
Background A 57% increase in the U.S. prevalence of autism spectrum disorders (ASD) for 8-year-old children born in 1994 versus 1998 was recently reported.Methods To quantify the possible contributions of given risk/predictive factors on the recent ASD prevalence increase, we formulated a mathematical model based on the baseline risk factor prevalence (RFP), the proportionate change in RFP (cRFP), and the magnitude of the association between the risk factor and ASD [estimated relative risk (RR)]. We applied this model to several pregnancy-related factors (preterm, very preterm, low and very low birth weight, multiple birth, cesarean delivery, breech presentation, and assisted reproductive technology use). RFP and cRFP estimates for each factor were obtained from U.S. population-based surveillance datasets. Estimated RRs were obtained from a series of systematic literature reviews.Results We estimate that each risk factor examined, alone or in various combinations, accounted for a very small proportion (<1%) of the ASD increase. Additionally, hypothetical scenarios indicate RFP, cRFP, and RR all need to be sizable for a risk factor to appreciably influence ASD prevalence.Conclusions Thus, although various pregnancy factors have been found to be associated with ASDs, the contribution of many of these factors to the recently observed ASD increase is likely minimal.
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Multiple studies have found associations between adverse perinatal outcomes or complications and autism spectrum disorder.
“Numerous studies establish associations between adverse perinatal outcomes/complications and autism spectrum disorder (ASD).”
PTB, SGA, and CD have been established as ASD risk factors through multiple studies in a range of populations.
“We chose factors that were both relatively common (≥10% population prevalence) and thus could substantively contribute to the population ASD burden and established as ASD risk factors through multiple studies in a range of populations [12].”
The matched odds ratios for each perinatal factor (1.1-1.5 overall) agree with earlier studies and fall near the lower end of estimates from a systematic review.
“The risk factor-ASD matched ORs reported here (1.1–1.5, for each perinatal factor overall) are in line with previous studies, albeit toward the more conservative end of the range of estimates we recently reported from a systematic literature review [12].”
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- Authors
- Schieve, L. A., Rice, C., Devine, O., Maenner, M. J., Lee, L.-C., Fitzgerald, R., Wingate, M. S., Schendel, D., Pettygrove, S., van Naarden Braun, K., & Durkin, M.
- Affiliations
- Centers for Disease Control and Prevention (US)
- University of Wisconsin–Madison (US)
- Johns Hopkins University (US)
- Washington University in St. Louis (US)
- University of Alabama at Birmingham (US)
- University of Arizona (US)
- Corresponding author
- Schieve, Laura A.
- ORCID
- Venue
- Annals of Epidemiology
- Publisher
- Elsevier BV
- Published
- 2011-12
- Volume
- 21
- Issue
- 12
- Pages
- 930-945
- ISSN
- 1047-2797 (ISSN-L)
- PMC
- PMC4351770
- OpenAlex
- W2160431279
- Cited by
- 58
- References
- 71
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 3 · 2023: 2 · 2022: 3 · 2021: 2 · 2020: 2 · 2019: 4 · 2018: 2 · 2017: 6 · 2016: 3 · 2015: 7 · 2014: 13 · 2013: 5 · 2012: 4
- FWCI
- 3.57
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Annals of Epidemiology (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (P30HD003352)
- Topics
- Life Sciences › Neuroscience › Cognitive Neuroscience › Autism Spectrum Disorder Research
- Health Sciences › Medicine › Psychiatry and Mental health › Child Nutrition and Feeding Issues
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
- Keywords
- autism spectrum disorder, perinatal risk factors, secular trends, relative risk, mathematical risk model, preterm birth, low birth weight, multiple births, cesarean section, breech presentation, assisted reproduction, pregnancy factors
- MeSH terms
- Autistic Disorder, Child, Child, Preschool, Female, Humans, Infant, Infant, Newborn, Male, Models, Theoretical, Population Surveillance, Pregnancy, Risk, United States, Prevalence, Risk Assessment, Perinatal Care
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