Oberg Anna Sara, D'Onofrio Brian M, Rickert Martin E, Hernandez-Diaz Sonia, Ecker Jeffrey L, Almqvist Catarina, Larsson Henrik, Lichtenstein Paul, Bateman Brian T
Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts2Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
Department of Psychological and Brain Sciences, Indiana University, Bloomington.
JAMA Pediatr. 2016 Sep 6;170(9):e160965. doi: 10.1001/jamapediatrics.2016.0965.
Induction of labor is a frequently performed obstetrical intervention. It would thus be of great concern if reported associations between labor induction and offspring risk of autism spectrum disorders (ASD) reflected causal influence.
To assess the associations of labor induction with ASD, comparing differentially exposed relatives (siblings and cousins discordant for induction).
DESIGN, SETTING, AND PARTICIPANTS: Follow-up of all live births in Sweden between 1992 and 2005, defined in the Medical Birth Register. The register was linked to population registers of familial relations, inpatient and outpatient visits, and education records. Diagnoses of ASD were from 2001 through 2013, and data were analyzed in the 2015-2016 year.
Induction of labor.
Autism spectrum disorders identified by diagnoses from inpatient and outpatient records between 2001 and 2013. Hazard ratios (HRs) quantified the association between labor induction and offspring ASD. In addition to considering a wide range of measured confounders, comparison of exposure-discordant births to the same woman allowed additional control for all unmeasured factors shared by siblings.
The full cohort included 1 362 950 births, of which 22 077 offspring (1.6%) were diagnosed with ASD by ages 8 years through 21 years. In conventional models of the full cohort, associations between labor induction and offspring ASD were attenuated but remained statistically significant after adjustment for measured potential confounders (HR, 1.19; 95% CI, 1.13-1.24). When comparison was made within siblings whose births were discordant with respect to induction, thus accounting for all environmental and genetic factors shared by siblings, labor induction was no longer associated with offspring ASD (HR, 0.99; 95% CI, 0.88-1.10).
In this nationwide sample of live births we observed no association between induction of labor and offspring ASD within sibling comparison. Our findings suggest that concern for ASD should not factor into the clinical decision about whether to induce labor.
引产是一种经常进行的产科干预措施。因此，如果所报告的引产与后代患自闭症谱系障碍（ASD）风险之间的关联反映了因果影响，那将令人高度担忧。
评估引产与ASD之间的关联，比较暴露情况不同的亲属（引产情况不一致的兄弟姐妹和表亲）。
设计、设置和参与者：对1992年至2005年瑞典所有活产进行随访，数据来自医疗出生登记册。该登记册与家庭关系人口登记册、住院和门诊就诊记录以及教育记录相链接。ASD诊断时间为2001年至2013年，数据于2015 - 2016年进行分析。
引产。
通过2001年至2013年住院和门诊记录诊断出的自闭症谱系障碍。风险比（HRs）量化了引产与后代ASD之间的关联。除了考虑一系列已测量的混杂因素外，对同一女性暴露情况不一致的出生情况进行比较，还能进一步控制兄弟姐妹共有的所有未测量因素。
整个队列包括13629
