The Association Between Prenatal and Neonatal Complications and Autism Spectrum Disorder in the Child

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  • March 21, 2019
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  • Cordero, Christina
    • Affiliation: Gillings School of Global Public Health, Department of Epidemiology
Abstract
  • The documented prevalence of autism spectrum disorder (ASD) has increased in recent years. ASD is a heterogeneous group of neurodevelopmental disorders with multiple factors involved; however, specific causal factors remain relatively unknown. Previous studies have shown associations between prenatal and neonatal complications and neurodevelopmental disorders. However, they are limited by small samples sizes, the use of administrative data, or by not accounting for confounding or interaction. To address these limitations, this study utilized data from the Study to Explore Early Development, a population-based case-control study with data from medical records and maternal report collected from six study sites located in the United States. A clinical evaluation classified each child as meeting criteria for ASD (ASD n=698), having a developmental disorder or delay without traits of ASD (DD n=887), or as a population control (POP n=979). In Aim 1, we evaluated the association between maternal diabetes (n=246) and hypertensive disorders (n=386) and ASD, two common complications of pregnancy. In Aim 2, we evaluated the association between neonatal jaundice (n=1239) and ASD, which is variably associated with ASD in previous literature. In our analysis, we controlled for confounding and assessed whether the observed associations were modified by other factors such as maternal body mass index and gestational age. We evaluated how associations varied when comparing ASD to POP versus DD to POP, allowing us to determine if associations are specific to ASD. In Aim 1, we found an association with maternal hypertensive disorders and ASD (aOR=1.67[95% CI 1.25, 2.23]), and similarly with DD; but no association with diabetes and ASD. In Aim 2, neonatal jaundice was associated with ASD in infants born 35-37 weeks (aOR=1.83[95% CI 1.05, 3.19]) and also with DD, but not in infants born ≥38 weeks. Our findings suggest that maternal hypertensive disorders and neonatal jaundice are associated with ASD. Future studies should investigate the role of timing and severity of these disorders in association with ASD. These results can help identify children at higher risk of developmental disorders for whom developmental screening at younger ages may allow for identification at younger ages and potentially earlier intervention.
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  • In Copyright
Advisor
  • Herring, Amy
  • Engel, Stephanie
  • Siega-Riz, Anna Maria
  • Daniels, Julie
  • Vladutiu, Catherine
Degree
  • Doctor of Philosophy
Degree granting institution
  • University of North Carolina at Chapel Hill Graduate School
Graduation year
  • 2017
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