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Autism linked to induced or augmented labor, study says
August 12th, 2013
04:01 PM ET

Autism linked to induced or augmented labor, study says

As scientists struggle to understand the causes of autism, a potential new pattern has emerged: The condition is associated with induced or augmented labor, according to a new study.

Induction means stimulating contractions before spontaneous labor begins. Augmentation means helping contractions become stronger, longer or more frequent. Both of these methods of expediting deliveries have helped mothers who have health conditions that could be detrimental to them or their child.

The researchers did not prove that these treatments cause autism. Women should not read the new study, which is published in the journal JAMA Pediatrics, and decide against expediting labor on that basis, said Simon Gregory, researcher at Duke University Medical Center and lead author of the study.

"It’s a decision between them and their healthcare provider," Gregory said, but the data do not "outweigh the risks that would come with just not wanting to be induced or augmented at all, because then you’re the placing the mother and the infant’s life at risk."

Background

Autism spectrum disorders are developmental conditions characterized by social, communication and behavioral difficulties.

About 1 in 88 children has a diagnosed autism spectrum disorder, according to the latest estimate from the Centers for Disease Control and Prevention.

Although there is evidence that genetics plays a role, environmental factors may also be at play in altering normal development. A recent study of twins found that susceptibility to autism can increase in prenatal and early postnatal environments.

Methods

The study looked at more than 625,000 records of children's birth and education from North Carolina. Researchers obtained information on the demographics of both parents, the mother's medical history age at pregnancy, and infant health.

Although this is a large sample size, study authors could not control for every variable that might have influenced the results. They did not have information about paternal age, for example, or what medications the mothers were taking. Researchers also did not obtain data about where on the autism spectrum the children fall in this study.

Results

Researchers found a strong link between treatments to expedite labor and males who had autism; for females, less so.

Male infants born in deliveries in which labor was both induced and augmented were 35% more likely to have autism than those whose mother did not have either of these treatments. For induction alone, risk was elevated 18%. For augmentation alone, risk went up 15%.

The risk to females was not significantly elevated when labor was both induced and augmented, or induced alone. The likelihood of autism went up with augmentation alone, 21%.

"The risk is modest but significant, particularly considering that this is a potential risk factor many pregnant women may be exposed to during labor," according to a statement from Autism Speaks, a leading autism science and advocacy organization.

The gender gap seen in the study is intriguing to scientists, Gregory said, because autism is more common in males in general - in fact, nearly five times as many boys than girls have autism spectrum disorders.

What it means, however, is unclear.

Researchers also found support for other autism risk factors that previous studies have established. Older maternal age raised the risk 30%, being first born increased risk 21%, and having a mother with gestational diabetes upped the risk by 24%.

They did not find any increased risk for children born in Cesarean sections compared to vaginal births.

Implications 

This data does not demonstrate that induced or augmented labor causes autism. It only shows an association; scientists do not yet know what explains the connection.

Gregory said there could be a number of underlying factors that this study did not directly address, including the health of the mother, drugs used to induce or augment birth, fetal stress, or other medications that the mother is taking. The act of inducing or augmenting may be to blame, but alternatively the medical and obstetric conditions around those treatments could have something to do with it, or even some other events that commonly occur to women whose labor is expedited. At this stage, no one knows.

But researchers say the underlying mechanism is worth looking into, given that expedited labor isn't rare. About 23% of births in the United States in 2008 were induced, and 17% were augmented in 2002, Gregory said.

"This is the largest study to date demonstrating an association between induced or augmented childbirth and autism, and the next step is for research to better understand the possible mechanisms behind this relationship," according to a statement from Autism Speaks.

Gregory and colleagues want to go back to these medical records and dig deeper, but also study other mothers and children going forward to see if they can figure out why they're at increased risk.

More: Prenatal exposure to pollution raises risk of autism in kids

CNN's John Bonifield contributed to this report 


soundoff (193 Responses)
  1. Glenn

    Correlation but, as of yet, no causation. For all we know there could be a common factor that both causes mothers to need induced labor and causes autism, as opposed to induced labor causing autism.

    August 13, 2013 at 11:48 | Report abuse | Reply
    • Joe

      You hit the nail on the head right there, this is exactly what I thought as soon as I read this article. The report freely claims that the researchers knew nothing of the mother's prior conditions or medications during pregnancy. It disgusts me that these researchers went to publication with such extreme findings without ever actually validating their conclusions. All this report will do is spark more controversy over the autism debate, waste more research dollars in the effort to debunk or substantiate the claims, and possibly harm mothers and children alike as they forgo inducing labor because it might give their children autism. It's shabby scientific work like this that lead to a decade of unnecessary research about vaccines causing autism due to a single researcher who was corrupt and just out to pad his own wallet. Making claims like this in no way progresses the understanding or search for a cure to autism and instead sets us back needlessly.

      August 13, 2013 at 15:25 | Report abuse |
    • SixDegrees

      Ok. So what? That there's a connection noted is the interesting thing. No one is claiming causality here.

      August 13, 2013 at 16:05 | Report abuse |
    • doctormelgar

      No one is claiming causality but that is the inference that many will make which is why its important to point out that no causal link has been established.

      August 13, 2013 at 21:39 | Report abuse |
    • Tiffany

      This may be valuable information for many women who choose to be induced, not because of a medical condition, but because they're tired of being pregnant and past 38 weeks, their OB says it poses no risk. More and more data shows that there are risks associated with induction, and those risks may weigh lightly if mom or baby is in distress, but the balance changes when mom and baby are otherwise healthy.

      August 14, 2013 at 00:14 | Report abuse |
    • eyes open

      Please read the article at the following link on Autsim

      http://thefullertoninformer.com/carbonyl-iron-and-orange-county-the-autism-capital-of-the-state/

      August 14, 2013 at 02:28 | Report abuse |
    • Diane H

      The following blog article out of Orange County California that exposes what we believe to be the direct cause of this disorder: http://thefullertoninformer.com/carbonyl-iron-and-orange-county-the-autism-capital-of-the-state/

      Please forward this to everyone that you know. The window of opportunity to stomp this out is wide open right now.
      Thank you.

      August 14, 2013 at 09:28 | Report abuse |
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      August 14, 2013 at 09:46 | Report abuse |
    • Susan

      Well, I am slightly autistic and my mothers labour was induced. But she also had polio and I was separated from her at birth and sent to my grandmother for six month.s I think breast feeding holds the key to happy and well adjusted children. But i observe that my father and elder brother also exhibit signs of autism so it may be hereditary.

      August 14, 2013 at 10:16 | Report abuse |
    • eyes open

      http://thefullertoninformer.com/carbonyl-iron-and-orange-county-the-autism-capital-of-the-state/

      August 17, 2013 at 02:30 | Report abuse |
    • Elisabeth

      Indeed, Glen.
      Take a look at Placental Sulfatase Deficiency (X-linked condition related to the STS gene).
      This could explain (can't bring myself to use 'cause' by nature!) the failure of onset of labour and the need for interventions, do you think?
      I'm in the "game" and it explains my son's inattentive ADHD (type without the hyperactivity but with big anxiety).

      November 20, 2014 at 21:00 | Report abuse |
  2. Jeanny

    Before 18 months my daughter couldn't have eye contact or said any single words. I did my own reading everyday. I put her on some diets and detox. After detox, she had the first eye contact with me just for one split second. It made me cries. After that she had speech and behavior therapy until 3 years old from Regional Center. Now she goes to regular school. She has just a little problems on controlling her temper and listening to the teacher. Other than that she is normal and healthy. Autism can be caused by so many things other than genetic. We are as parents should always read and contact your pediatrician so if there is something wrong, we could detect as early as possible. The brain of the kids grow until certain age and it can be helped. Always believe and don't give up.

    August 13, 2013 at 12:11 | Report abuse | Reply
  3. Jeanny

    In my opinion, Induced, vaccine, and many other things can caused Autism for certain kids. But we still need vaccine and induced for the mother's and kid's health. We just need all the kids to be checked and detoxed for all the chemical that can cause Autism.

    August 13, 2013 at 12:37 | Report abuse | Reply
    • Ann

      Unfortunately for your opinion (though I'm sure you hold many credentials) every verified medical study on this topic would prove you wrong... Vaccinations have zero correlation to autism.

      August 14, 2013 at 12:43 | Report abuse |
  4. Stephanie

    My son was not induced, but, I did not get to hold him for a couple of hours. My husband told me he was very cold and shivering as they cared for him during that time. I am convinced, that the over-sti mulation of the cold and the activity traumatized him. He was collic, and I finally realized that gently holding my hands over his ears would calm him. Now, he is 13 and continues to struggle with overstimulation, but is getting better at sociallizing and he is a straight A student. He also plays chess and the trombone. I just feel so guilty about his first hours after birth.

    August 13, 2013 at 14:10 | Report abuse | Reply
    • Faye

      Don't feel guilty. It's the way hospitals are made that is so cold and clinical that ultimately is at fault. A life coming into this world is no joke but the hospital staff are not really trained to be any other way.

      August 13, 2013 at 15:22 | Report abuse |
  5. Deanna

    All three of my children were induced and none of them are autistic. I think there are other factors that cause it and the induction might bring it out more but just because you are induced does not mean your child will be autistic. The same with if you have your child vaccinated they might or might not be autistic. there is something else in the background that when it is coupled with these things will increase the chances of autism.

    August 13, 2013 at 14:18 | Report abuse | Reply
    • SixDegrees

      The article notes that there is a genetic component involved with autism.

      Other researchers have noted that women who contract the flu while pregnant have a higher incidence of autistic offspring.

      But this is a big study, and a strong correlation. It can't be easily dismissed, and shouldn't be ignored.

      Meanwhile, the effect of vaccination on autism has precisely NO evidence supporting it whatsoever. None.

      August 13, 2013 at 16:07 | Report abuse |
    • eyes open

      EMF exposure

      http://www.thefullertoninformer.com

      August 17, 2013 at 02:32 | Report abuse |
  6. Maria Jimenez

    I think autism is due to having one of the parents with the problem of drinking alcohol prior to been ready to have kids. If one of them was alcoholic, some of their brain cells had been mutilated by the situation of alcoholism then the child inherits the same dead cells in their brain.

    August 13, 2013 at 14:27 | Report abuse | Reply
    • Amy

      Neither my husband or I have ever drunk alcohol and our first born son is autistic. We know a few other families that could say the same.

      August 13, 2013 at 14:47 | Report abuse |
    • Jessica

      Anything related to alcohol would fall under Fetal Alcohol, not Autism... they may have some similar characteristics, but they shouldn't be confused as the same disorder.

      August 13, 2013 at 19:51 | Report abuse |
    • Jami

      You don't know what you are talking about. There is no correlation or reason to suggest that alcohol has anything to do with autism. Drinking during pregnancy can cause FAS, but not autism. My husband and I have never really drank more than a drink on a rare special occasion. Our middle child has autism. The only one of my births that had any Pitocin, I was bullied into augmentation with him when my labor stalled. This article and the research does not surprise me, but it angers me. A lot. When we mess with the natural order of things and interfere in normal processes, bad things happen. The use of Pitocin has become extremely common. Its time for doctors to realize that they are messing with people's LIVES here, not just speeding up a process without consequence. Women of the world, trust your bodies, and beware of those who do not!

      August 13, 2013 at 21:23 | Report abuse |
    • Tiffany

      Um, lack of or damage to brain cells in parents has NOTHING to do with sex cells, egg or sperm. Now, if the mother were to be drinking while pregnant, that can cause problems. But, brain cells in the parents has no effect on the developing child. Basic biology.

      August 13, 2013 at 21:38 | Report abuse |
    • Blake

      Dead brain cells cannot be genetically inherited. Alcohol in a pregnant mother's system can potentially cause damage to the embryo who is exposed to the alcohol, but that has nothing to do with the genes.

      August 14, 2013 at 05:05 | Report abuse |
  7. Bob

    "The gender gap seen in the study is intriguing to scientists, Gregory said, because autism is more common in males in general – in fact, nearly five times as many boys than girls have autism spectrum disorders. What it means, however, is unclear."

    No, it's very clear. This is another half-baked "scientific" study trying to figure out where autism comes from. If the data had shown that 5 times as many males are delivered using the augmented methods, then they might be on to something. However, I'm guessing that the percentages for male vs. female delivery using these methods is around 50-50. I call BS on this report.

    August 13, 2013 at 14:29 | Report abuse | Reply
    • Globetrotter5K

      Good point on the numbers; if there is already a significantly higher number of boys than girls being born with autism then it makes those born by induced or augmented births would also be significantly higher (male : female) so redundant information that should not be factored in when determining correlation.

      August 13, 2013 at 18:48 | Report abuse |
  8. SeriouslyThough

    What isn't linked to Autism or heart disease?

    August 13, 2013 at 14:52 | Report abuse | Reply
    • SeriouslyThough

      Or Alzheimer's?

      August 13, 2013 at 14:52 | Report abuse |
  9. Jessica

    I have three daughters, all diagnosed with Autism on some level. My youngest was the only one who was induced and she is very high functioning. My oldest, I might have had some pitocin to help strengthen my contractions, but that was 16 years ago when they didn't like using pitocin so I might not have gotten it. My middle daughter is the most severely impacted by her Autism and she was not induced as my labor with her was only 90 minutes long. So I find this study does not apply to us and I don't really see how they can make this conclusion. It is almost along the lines of saying if you mom had brown eyes or your dad had red hair, your chance is increased. I think further research is needed before they truly go linking induced or augmented labor to Autism as I know several moms who have kids with ASD and had neither of those aides in their labor.

    August 13, 2013 at 15:04 | Report abuse | Reply
    • SixDegrees

      As the article notes, there is a genetic component to autism. Given that three of your children have it, I'd say that's what's at work here more than any other factor.

      August 13, 2013 at 16:03 | Report abuse |
  10. sara r.

    The fact is that induction of labor should only be allowed when the health of the mother and baby demand it. Obviously that is not happening, since nearly 40% of labors are induced or augmented. Studies like this confirm that there are risks that doctors may not be taking into consideration when they recommend induction. I know several women recently who were induced simply because their babies were "too small". Studies show that these babies are not at risk if labor is allowed to start on it's own, but instead are born later and bigger, on average. But instead one friend ended up with a c-section and another a 2.5 day long induction, both quite possibly unnecessary. Both women had otherwise healthy and uneventful pregnancies. These studies are important if they make doctors think twice and three times about inducing babies that are clearly not ready to come out.

    August 13, 2013 at 16:03 | Report abuse | Reply
    • SixDegrees

      No, this study confirms nothing, except for a connection between induction and autism. It doesn't establish causality by any stretch of the imagination. It suggests that more research is needed to determine exactly why there is such a link.

      Put your unfounded agenda aside. There are more important things.

      August 13, 2013 at 16:11 | Report abuse |
    • Thinking things through

      I was induced because my mother had toxemia. My brother was induced because the doctor wanted to go on vacation. Neither of us are autistic. I'm with those who want this study sorted further into rationales for induction (or augmentation), so a more clear understanding of why the correlation exists, can emerge. I seriously doubt it is the induction in itself. Medical histories are needed to encourage real answers.

      August 14, 2013 at 07:11 | Report abuse |
    • Thinking things through

      (My point here is that there are many reasons babies are induced....)

      August 14, 2013 at 07:30 | Report abuse |
    • AbbyJ

      Thinking things through, induced because the doctor wanted to go on vacation? That is a horrible and irresponsible reason to induce. Possible autism risk aside, inducing is not without risk. Inducing labor increases the chances more interventions will be needed, including increased risk of c-section.

      We need to let babies come when they are ready! Up to 42 weeks, there is no increased risk to the baby staying in longer. According to Harvard, average human gestation is 41 weeks 1 day. Yet we have so many people, both pregnant women and doctors alike, who are ready to induce as soon as the due date, 40 weeks, hits.

      My baby was born 6 days late, so I know what it's like to be "overdue"; but I was prepared to wait as long as the doctors would let me, which they would allow up to 42 weeks.

      I went to an OB office that had several doctors they rotated the women through, so whoever delivers the baby is somebody you've at least had a couple appointments with before. The doctor that I considered my "main" doctor, and who was also luckily the one on-call when I delivered, was very supportive of waiting for labor to happen naturally and also pro-natural childbirth. But another doctor in the office was asking me several weeks before my due date about getting an induction on the schedule; NO MEDICAL REASON, just because "well, past the due date means induce!". That doctor was also big on pushing the epidural and other medications during labor/delivery.

      August 14, 2013 at 12:33 | Report abuse |
  11. inyri

    This is all correlational, particularly since we already have some data suggesting a relationship between autism and increasing maternal age (older mothers need more monitoring and non-stress tests, and may be induced more frequently due to a nonreassuring NST) and autism and gestational diabetes (again, more monitoring- and these babies have an increased risk of macrosomia, which can also be an indication for induction or a reason that labor may need to be augmented). There's no causative relationship here, and I hope people don't avoid necessary inductions because of this study.

    August 13, 2013 at 16:29 | Report abuse | Reply
  12. Amy

    My son on the spectrum (now 9) was born via emergency C-section. I had no labor with him. So ...

    August 13, 2013 at 18:56 | Report abuse | Reply
    • SixDegrees

      So...nothing. They're looking for statistical correlation here over large groups, not personal anecdotes, which are meaningless.

      August 13, 2013 at 19:00 | Report abuse |
  13. Hatsmazz

    I have a child with mild autism and yes, he was an induced labour. Just wondering if the study corrected for fathers who are on the spectrum? We have never really worried about my son's autism as his Dad is Aspergers anyway – never diagnosed because it wasn't important when he was a kid. There is a genetic link for autism so the study should correct for that in order to be stronger.

    August 13, 2013 at 19:24 | Report abuse | Reply
  14. Amelia

    I am an older mom 45 with a first born and had gestational diabetes but delivered by c section. My daughter is not autistic. If I had induced labor or augmented as the dr was considering maybe it would have been 99 percent chance..

    August 13, 2013 at 21:51 | Report abuse | Reply
  15. dario

    I'd like to know when are they going to minimally consider the relation between Autism and the chemicals as Alumium,Antibiotics,Eggprotein,Formaldehyde,Monosodium glutamate (MSG),Thimerosal present in them! Are they blind or just dishonest people trying to make us as dumb as they can?

    August 13, 2013 at 22:03 | Report abuse | Reply
    • SixDegrees

      There's no relation to consider. Researchers are more concerned with uncovering and examining actual facts and evidence, not spending their time on bug-eyed Internet phantasms.

      August 14, 2013 at 04:20 | Report abuse |
    • piece2u

      I agree with you Dario. These chemicals effect us. I feel that msg is one of the biggest culprit, its in almost everything, in one form or another.

      August 14, 2013 at 09:35 | Report abuse |
    • Elisabeth

      Genetics, viruses, lack of contact with nature and good food (to get good biota) are all shown to be more likely factors which are far more worthy of investigation that those on your list.

      November 20, 2014 at 20:55 | Report abuse |
  16. Sorcha

    So, basically another Non Story full of crap. No hard info but one hell of a Lead In Headline. IF A might equal B, then C might equal F...that is about all this article really says. So fine again CNN. Does anyone there know what JOURNALISM means?

    August 13, 2013 at 23:21 | Report abuse | Reply
    • SixDegrees

      "Male infants born in deliveries in which labor was both induced and augmented were 35% more likely to have autism than those whose mother did not have either of these treatments. For induction alone, risk was elevated 18%. For augmentation alone, risk went up 15%."

      Oh, look – hard info.

      Next time, try to do more than just look at the pictures.

      August 14, 2013 at 04:19 | Report abuse |
  17. eyes open

    http://thefullertoninformer.com/carbonyl-iron-and-orange-county-the-autism-capital-of-the-state/

    August 14, 2013 at 02:27 | Report abuse | Reply
  18. Ezenbin

    OK, here's an idea they could look into, how about the absence of Braxton Hicks contractions during pregnancy? I think this is due to low levels of oxytocin, the hormone given to cause contractions and move labor along. A woman who is not producing enough will need to be administered this drug and that would be the reason for the correlation they've seen here. Oxytocin is the "bonding" hormone, isn't it? It's a question I've never seen the researchers ask, "did you have Braxton Hicks contractions during pergnancy?"

    August 14, 2013 at 07:32 | Report abuse | Reply
    • Elisabeth

      I agree there is definitely a link!
      Breastfeeding (lactation) has been shown to upregulate oxytocin in the mother.
      I breastfed my son for 2 years and have never in my life felt so wonderful, both during pregnancy and while breastfeeding! I've struggled with depression my entire life, lack of trust and shyness (although i've always been social ).
      CD38 gene is linked to oxytocin regulation (knockout the gene and you get lower oxytocin levels).
      Sadly, oxytocin is still not on the market for depression.

      November 20, 2014 at 20:53 | Report abuse |
  19. Joshua Mills

    kind of makes you think about induction... hmm

    http://www.laboraide.com/article/1423-the-basics-of-labor-induction

    August 15, 2013 at 04:41 | Report abuse | Reply
  20. wwlindberg

    More BS lies from scientist who have their head up their asses, my daughter wasnt induced so what do they say about that? and my daughter was already special needs before she got the MMR so now what causes Autism huh?

    August 15, 2013 at 11:33 | Report abuse | Reply
    • wwlindberg

      in fact they thought she would have downs or even fragile x syn. when she was still in the womb. but no it was Autism

      August 15, 2013 at 11:35 | Report abuse |
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  22. Tracey

    I'm fascinated by this article and it's the first I've heard of it. I have 3 boys – my eldest and youngest are on the spectrum. My older boy was overdue by 11 days and I had a very difficult birth. My middle son 5 days late and slipped into the world with minimum effort from either of us and my last son was a week late and had to be induced twice as labour stopped mid way. Again it was a difficult birth and he is now quite severly autistic. I have always linked it to their birth but have been laughed at for thinking so. The use of the MMR vaccine was massive news in the UK at the time of his infancy so we paid to have individual vaccines therefore I can rule that out as a possible cause. The cause is almost irrelevant now to me, just taking care of him from day to day is my priority but if anything can be found to help other families it is worth investigating.
    As you will see from this post I am no scientist or medical professional just a simple lay person with an interest in the research being done.

    August 30, 2013 at 13:43 | Report abuse | Reply
    • Elisabeth

      It may be PLACENTAL SULFATASE DEFICIENCY AND AN STS GENE VARIANT (X-LINKED)
      Mothers who are overdue, fail to have a natural labour and who are induced or have a caesarian may have an infant with an STS gene variant which causes placental sulfatase deficiency (PSD), an X-linked genetic condition (on the X chromosome therefore only affects males).
      My obstetrician diagnosed this condition when my son was born. I was 2 weeks overdue and had no labour despite efforts to induce me. Dr insisted labour problems would be the only issue my son would suffer. He was wrong!
      My son suffered extreme anxiety at 4 and was finally diagnosed with inattentive subtype of ADHD (no hyperactivity). Medication cured the anxiety in a week!
      There is increasing literature on this topic – eg. W Davies (UK).
      It seems the failure of onset of labour is rarely put down to PSD. It was pure chance given my knowledge and my doctor's that led to the dx.

      November 20, 2014 at 20:43 | Report abuse |
  23. howard

    Does anything not cause autism?

    October 23, 2013 at 09:20 | Report abuse | Reply
    • Elisabeth

      The right combination of genetics. Autism is highly heritable. Environmental factors, especially prenatally (viruses, maternal diet, etc) may worsen the outcome.

      November 20, 2014 at 20:37 | Report abuse |
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  25. Elisabeth

    PLACENTAL SULFATASE DEFICIENCY AND STS GENE VARIANT (X-LINKED)
    Mothers who fail to have a natural labour and who are induced or have a caesarian may have an infant with the STS gene variant and placental sulfatase deficiency (PSD) which is X-linked (on the X chromosome therefore only affects males).
    My obstetrician diagnosed this condition when my son was born. He insisted this was the only issue my son would suffer. He was wrong!
    My son suffered extreme anxiety at 4 and was finally diagnosed with inattentive subtype of ADHD.
    There is increasing literature on this topic.
    It seems the failure of onset of labour is rarely put down to PSD.

    November 20, 2014 at 20:34 | Report abuse | Reply
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