Van Naarden Braun Kim, Schieve Laura, Daniels Julie, Durkin Maureen, Giarelli Ellen, Kirby Russell S, Lee Li-Ching, Newschaffer Craig, Nicholas Joyce, Pinto-Martin Jennifer
Developmental Disabilities Branch, National Centers on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 1600 Clifton Road (MS E-86), Atlanta, GA 30333, USA.
Autism Res. 2008 Oct;1(5):266-74. doi: 10.1002/aur.41.
Since the 1970s, the prevalence of multiple births (MBs) in the United States has increased significantly. This has been attributed, in large part, to iatrogenic MBs resulting from infertility treatments that include ovulation stimulation. A past study has indicated that children from MBs have an increased prevalence of cerebral palsy (CP). Other studies also have suggested an association between MBs and intellectual disabilities (ID) and autism spectrum disorders (ASDs); however, results have been inconsistent. From the Autism and Developmental Disabilities Monitoring (ADDM) Network, a surveillance project among several US populations, we obtained MB estimates among children born in 1994 and classified by 8 years of age as having: an ASD (n=1,626 total children from 11 sites; 50 born as part of an MB); CP (n=302 total children from 3 sites; 25 born as part of an MB); or ID (n=1,195 total children from 3 sites; 45 born as part of an MB). All three MB estimates were notably higher than age-adjusted expected estimates of naturally conceived MBs derived from 1971 US natality data. However, when MB estimates from the ADDM Network were compared with expected MB estimates derived from 1994 natality data for the states corresponding to the relevant ADDM Network sites, we observed no association with ASDs (observed/expected=1.08 [0.78-1.38]), a moderate, but not statistically significant association with ID (observed/expected=1.34 [0.95-1.73]), and a strong association with CP (observed/expected=2.96 [1.80-4.12]). Further investigation of specific types of MBs (natural vs. iatrogenic) is warranted.
自20世纪70年代以来，美国多胞胎（MBs）的患病率显著上升。这在很大程度上归因于包括促排卵在内的不孕治疗导致的医源性多胞胎。过去的一项研究表明，多胞胎出生的儿童患脑瘫（CP）的患病率有所增加。其他研究也表明多胞胎与智力残疾（ID）和自闭症谱系障碍（ASD）之间存在关联；然而，结果并不一致。通过自闭症和发育障碍监测（ADDM）网络，这是一项针对美国多个群体的监测项目，我们获得了1994年出生并在8岁时分类为患有以下疾病的儿童中的多胞胎估计数：自闭症谱系障碍（来自11个地点的1626名儿童；50名作为多胞胎的一部分出生）；脑瘫（来自3个地点的3个02名儿童；25名作为多胞胎的一部分出生）；或智力残疾（来自3个地点的1195名儿童；45名作为多胞胎的一部分出生）。所有这三项多胞胎估计数均明显高于根据1971年美国出生数据得出的年龄调整后的自然受孕多胞胎预期估计数。然而，当将ADDM网络的多胞胎估计数与根据与相关ADDM网络地点对应的州的1994年出生数据得出的预期多胞胎估计数进行比较时，我们观察到与自闭症谱系障碍无关联（观察值/预期值 = 1.08 [0.78 - 1.38]），与智力残疾有中度但无统计学意义的关联（观察值/预期值 = 1.34 [0.95 - 1.73]），与脑瘫有强关联（观察值/预期值 = 2.96 [1.80 - 4.12]）。有必要对特定类型的多胞胎（自然受孕与医源性）进行进一步调查。
