Department of Sociology, College of Social Sciences, University of California, Los Angeles, Los Angeles, California; California Center for Population Research, College of Social Sciences, University of California, Los Angeles, Los Angeles, California; RIKEN Center for Brain Science (CBS), Wako, Japan.
School of Social Work, Columbia University, New York, New York.
Am J Prev Med. 2022 Jul;63(1):68-76. doi: 10.1016/j.amepre.2022.01.024. Epub 2022 Mar 31.
Cesarean section and induced deliveries have increased substantially in the U.S., coinciding with increases in autism spectrum disorder. Studies have documented associations between cesarean section deliveries and autism spectrum disorder but have not comprehensively accounted for medical risks. This study evaluates the extent to which cesarean section and induced deliveries are associated with autism spectrum disorder in low-risk births.
In this retrospective cohort study, California's birth records (1992-2012) were linked to hospital discharge records to identify low-risk births using a stringent algorithm based on Joint Commission guidelines. Autism spectrum disorder status was based on California Department of Developmental Service data. Logistic regression models were used to estimate associations between autism spectrum disorder and induced vaginal deliveries, cesarean section deliveries not following induction, and cesarean section deliveries following induction, with noninduced vaginal deliveries as the reference category.
A total of 1,488,425 low-risk births took place in California from 1992 to 2012. The adjusted odds of autism spectrum disorder were 7% higher for induced vaginal deliveries (AOR=1.07, 95% CI=1.01, 1.14), 26% higher for cesarean section deliveries not following induction (AOR=1.26, 95% CI=1.19, 1.33), and 31% higher for cesarean section deliveries following induction (AOR=1.31, 95% CI=1.18, 1.45) than for noninduced vaginal deliveries. Lower gestational age and neonatal morbidities did not appear to be important underlying pathways. The associations were insensitive to alternative model specifications and across subpopulations. These results suggest that, in low-risk pregnancies, up to 10% of autism spectrum disorder cases are potentially preventable by avoiding cesarean section deliveries.
After accounting for medical risks, elective deliveries-particularly cesarean section deliveries-were associated with a substantially increased risk of autism spectrum disorder.
在美国，剖宫产和引产的数量大幅增加，同时自闭症谱系障碍的发病率也有所上升。已有研究记录了剖宫产与自闭症谱系障碍之间的关联，但并未全面考虑医疗风险。本研究旨在评估低危分娩中剖宫产和引产与自闭症谱系障碍之间的关联程度。
本回顾性队列研究将加利福尼亚州的出生记录（1992-2012 年）与医院出院记录相关联，以基于联合委员会指南的严格算法识别低危分娩。自闭症谱系障碍的状态基于加利福尼亚州发育服务部的数据。使用逻辑回归模型估计自闭症谱系障碍与诱导性阴道分娩、非诱导性剖宫产分娩和诱导性剖宫产分娩之间的关联，非诱导性阴道分娩为参考类别。
1992 年至 2012 年，加利福尼亚州共有 1488425 例低危分娩。与非诱导性阴道分娩相比，诱导性阴道分娩的自闭症谱系障碍调整后比值比（AOR）为 7%（95%CI=1.01，1.14），非诱导性剖宫产分娩的 AOR 为 26%（95%CI=1.19，1.33），诱导性剖宫产分娩的 AOR 为 31%（95%CI=1.18，1.45）。较低的胎龄和新生儿并发症似乎不是重要的潜在途径。这些关联在替代模型规范和亚人群中均具有稳健性。这些结果表明，在低危妊娠中，通过避免剖宫产分娩，多达 10%的自闭症谱系障碍病例可能是可以预防的。
在考虑医疗风险后，选择性分娩-特别是剖宫产-与自闭症谱系障碍的风险显著增加相关。
