University of Michigan research suggests inducing labor increases risk of autism
New findings by researchers at the University of Michigan suggest that women whose labor is induced or quickened may put their child at an increased risk for autism.
The finding enters an active field of research as the scientific community seeks answers to rising rates of autism in the U.S.
One in 88 children will have autism, according to the most recent data from the Centers for Disease Control and Prevention.
Marie Lynn Miranda
Courtesy of U-M
Previous studies on the issue have used data sets of several hundred people—which sets U-M's new study apart, said Marie Lynn Miranda, a professor of environmental informatics and pediatrics at U-M and a lead study author. Miranda is also dean of U-M's School of Natural Resources and Environment.
The research made use of a database of medical records in North Carolina first compiled in 2005 when Miranda was a professor a Duke.
In the data set, 1.3 percent of male children and 0.4 percent of female children were autistic—which is consistent with national trends, Miranda said. Miranda said the difference between genders was statistically significant.
There is no equivalent database in Michigan, though researchers are trying to gain access to medical records to conduct similar studies, Miranda said.
A review of all births in North Carolina over an eight-year period revealed that among male children, there was a 35 percent higher risk for autism whose mothers had their labor induced and augmented.
Children diagnosed with autism were also more likely to have been in fetal distress during birth, the study found.
Although the research findings don’t warrant a change in clinical practices regarding inducing or augmenting labor, Miranda said the study does make it important to pursue additional clinical research on the topic sooner rather than later.
Autism is a developmental disability that can cause social, communication and behavioral challenges.
Induced labor stimulates contractions before spontaneous labor occurs during childbirth. Augmented labor increases the strength, duration or frequency of contractions. Both types of stimulated labor can be prompted by medication or other techniques.
Miranda advised families of children with autism and prospective mothers to continue to discuss concerns or questions with their doctors, and to understand that the research findings don’t recommend changes in clinical practice at this point.
Further research is needed to understand the causation behind the correlation, Miranda said.
“The scientific community has an obligation to families of children with autism to see if we can prevent cases in the future,” Miranda said.
Amy Biolchini covers Washtenaw County, health and environmental issues for AnnArbor.com. Reach her at (734) 623-2552, amybiolchini@annarbor.com or on Twitter.
Comments
dfossil
Wed, Aug 14, 2013 : 11:07 a.m.
So far; Obese Mothers, Older Fathers, Pollution in the air, Mothers with diabetes, those who take anti-epilepsy drug, Valporoate and vaccinations all cause Autism. These increase the guilt the poor parents feel over their child's disorder, solves nothing and reduce the credibility of medical research as a real source of help. Researchers trying to justify monies spent on these studies do themselves no service by all these "statistical" twitches as the credibility of their work becomes more and more useless. They don't know what causes Autism. Why don't they just admit it!
Amy Biolchini
Tue, Aug 13, 2013 : 1:59 p.m.
The findings from this study were published in the Aug. 12 edition of Journal of the American Medical Association Pediatrics. http://archpedi.jamanetwork.com/journal.aspx
Jack Gladney
Tue, Aug 13, 2013 : 1:47 p.m.
Someone needs to alert America's Autism Expert Jenny McCarthy (former MTV personality, congressional expert witness, co-host of ABC's The View) that her kid, who as it turns out does not even have autism, may have not gotten it in childbirth instead of not getting it from mercury in vaccines.
jmac
Tue, Aug 13, 2013 : 1:28 p.m.
Can you provide the journal name that the study was published in? I'd like to check whether other concomittant factors - gestation time, co-morbidities (pre-eclampsia, gestational diabetes, etc) - were equivalent in the induced and non-induced groups. The finding that fetal distress was more common in the induced group makes me think there was more going on here than the induction issue.
Ed Kimball
Wed, Aug 14, 2013 : 10:26 a.m.
But which is cause and which is effect? Is the inducement causing the distress or or doctors inducing to try to reduce distress already observed?
Meg
Wed, Aug 14, 2013 : 4:03 a.m.
Fetal distress is generally more common in inductions than in spontaneous labor, period. It's not a surprise that this was a finding in this study as well.
Laurie Barrett
Tue, Aug 13, 2013 : 12:42 p.m.
Medicine has always been hamfisted.
Tano
Tue, Aug 13, 2013 : 1:30 p.m.
as is the case for all human endeavors...
aroundthewaygirl
Tue, Aug 13, 2013 : 1:25 a.m.
It would be interesting to know if there was a difference in autism rates for inductions performed earlier in pregnancy for reasons such as pre-eclampsia, large estimated fetal size, complications from gestational diabetes, etc. versus the rates in the induction of babies who were simply late term. I have been curious about the connection of the use of pitocin and the autism rates for a while now so it's interesting to see this research.
Meg
Tue, Aug 13, 2013 : 1:21 a.m.
UloveM: Approximately a third of all births have a nuchal cord, the vast majority of which are safely born vaginally. Would you care to explain why you think they should all be stat sections,
Meg
Wed, Aug 14, 2013 : 4:02 a.m.
No, you're missing the point. Where is your evidence that a section for a nuchal cord is safer for baby, or that it's less painful for the woman? Since c-sections increase the risk of respiratory problems in the infant, and, you know, death, infection, chronic pain, and breastfeeding difficulties for the woman, what's the evidence that a nuchal cord is problematic? (Hint: There isn't any. You can either reduce a nuchal cord, deliver the baby through it in a somersault maneuver, or clamp and cut. But you have a nice day now.)
UloveM
Wed, Aug 14, 2013 : 1:25 a.m.
safer for baby, less suffering for mom.
a2trader
Tue, Aug 13, 2013 : 12:47 a.m.
Amy - can you please provide where we can read the study report? Induction can be used for all sorts of reasons. Our ob/gyn scheduled induction for our oldest because he was late-term. When our #2 was also late, the same ob/gyn wanted to induce again and we refused when an ultrasound showed the baby was fine. Only then were we smart enough to realize our solo practitioner ob/gyn liked to induce because it was easier to manager her calendar. It had nothing to do with medical need or mom preference. I personally wonder why a 35% increase in risk wouldn't immediately cause all physicians/patients to change current practices. Perhaps the study report will explain why you would wait for more research?
TinyArtist
Tue, Aug 13, 2013 : 1:02 p.m.
1bit is right. The study is a just a heads up -- call it the Miranda Warning -- that something might be happening here. But correlation does not necessarily indicate causation, hence the need for more definitive studies.
1bit
Tue, Aug 13, 2013 : 2:17 a.m.
"I personally wonder why a 35% increase in risk wouldn't immediately cause all physicians/patients to change current practices. Perhaps the study report will explain why you would wait for more research?" The simple answer is because this study didn't really prove that point. Apologies if you are a statistician or research scientist, but an analogy would be if you walked outside every day for one week with an umbrella and the next week without one. The first week it rained every day and the next week it was sunny. So, did the umbrella cause it to rain? No, but you carrying it sure correlated with it raining. In medicine, this sort of thing happens a lot. When an actual prospective study is done that controls for confounding variables, most of these associations vanish. For example, a large study looking at people's diets may find higher cancer rates in people who drink coffee. The next step is a study where two groups are randomly assigned to drink coffee or water and see if there are differing rates of cancers. Getting back to this study in particular: if there is a 1.3% chance of autism for all male births and a 35% greater risk in the induced group, then the absolute risk of autism was 0.75% in the induced group and 0.55% in the non-induced group. So, it's a 0.2% absolute difference in rate of autism. This really is a small number to change practice patterns especially when the study wasn't designed for this question.
J. A. Pieper
Mon, Aug 12, 2013 : 11:53 p.m.
My son was induced because he was deemed large enough, not sure there was any other reason. The cord was wrapped around his neck, but quick action prevented any health issues for him. What I would like to know is what are the percentages of autistic children who were induced early? So if a child was not induced, and still ended up being on the spectrum, what cause would they attribute this to?
Tano
Tue, Aug 13, 2013 : 1:27 p.m.
@J.A. Pieper The study did not claim that induced labor causes autism. Merely that the two things are found together more often than expected randomly. They could, for example be both caused by some third factor, yet unexplained.
UloveM
Tue, Aug 13, 2013 : 12:57 a.m.
I can not believe that the Doctor would induce the labor if they found the cord was around a baby's neck. The correct procedural should be to stop the contractions, deliver the baby by C-section as emergency.
Paul
Mon, Aug 12, 2013 : 11:20 p.m.
So if you force the baby to be delivered early, its not very healthy for the baby. Who would had guess that, duh. How much did this study cost us taxpayers ? Doctors benefit all around. The less healthy the babies, the more often those people will need to see doctors throughout their lives. What a racked and all perfectly legal and accepted by many.
ThinkingOne
Tue, Aug 13, 2013 : 7:59 p.m.
Paul Despite all the stories about 'convenience' births, most births that are aided are because there is some kind of problem going on with the process. There is no mention of any study comparing what issues may result if assistance is NOT given. Nothing happens in a vacuum. Every action and every NON-action has results.
arborani
Tue, Aug 13, 2013 : 3:35 p.m.
@ Tano: very good point.
Tano
Tue, Aug 13, 2013 : 1:24 p.m.
@Paul That is not a necessary conclusion from the study. There may well be some set of factors that causes autism and also causes the need for labor to be induced. The study does not show, nor does not claim to show, that the induced labor causes the autism.
TinyArtist
Tue, Aug 13, 2013 : 12:53 p.m.
You broke your promise!
DwightSchrute
Mon, Aug 12, 2013 : 11:01 p.m.
Someone email this story to Jenny McCarthy, stat!
Dave66
Mon, Aug 12, 2013 : 11:29 p.m.
Drat. I said basically the same thing, but I didn't notice you got to it first.
trespass
Mon, Aug 12, 2013 : 10:57 p.m.
These kind of statistical studies are notoriously unreliable. You need to see the same finding in multiple databases and you need to test the hypothesis in a prospective study. There was a recently article about how drug companies have found that about 4 out of 5 statistical correlations that they were interested in that were published in scientific journals cannot be repeated by the drug companies. This is the kind of study that prematurely gets into the news media and makes mothers feel guilty.
1bit
Mon, Aug 12, 2013 : 10:23 p.m.
Correlation is not causation. Dr. Miranda says as much herself.
Basic Bob
Mon, Aug 12, 2013 : 9:56 p.m.
Still no word on which came first, chicken or egg.
arborani
Tue, Aug 13, 2013 : 3:33 p.m.
Very simple - eggs for breakfast, chicken for dinner. Egg came first.
Tano
Tue, Aug 13, 2013 : 1:21 p.m.
The egg IS the chicken at a younger age. So of course it comes first. The first chicken egg came from non-chicken parents.
TryingToBeObjective
Mon, Aug 12, 2013 : 8:59 p.m.
How about that. Now those anti-immunization folks have no reason not to immunize now.
arborani
Tue, Aug 13, 2013 : 3:32 p.m.
I suspect that Presidents - and other "haves" of their respective times - probably ate better, had the best of whatever medical treatment was available and (splitting logs aside) did not generally do physical work to the point of debilitation. Just sayin'.
M-Wolverine
Tue, Aug 13, 2013 : 1:06 p.m.
You can completely understand how someone can believe myths about immunization when they use individual examples of long life as proof after an article where statistical significance so important. Average age in the 1700 was around 30-35 years old. We did NOT live much longer (on average). http://emlab.berkeley.edu/users/webfac/carson/e113_su05/life.pdf Though it might be scientific fact that you live longer if you take the tin foil hat off.
Terri Eagen-Torkko
Tue, Aug 13, 2013 : 6:52 a.m.
Paul, autism has nothing to do with health.
snark12
Tue, Aug 13, 2013 : 4:58 a.m.
The average life span really was much, much lower 300 years ago. Here's a chart of US lifespan since 1850, for instance, when the average lifespan was less than 40. This is the AVERAGE, so it includes the many deaths in childhood. Sure, there were elderly people then but they were far rarer than today. http://pages.uoregon.edu/maphist/english/US/US39-01.html
Paul
Tue, Aug 13, 2013 : 12:14 a.m.
Last post-promise ! That dental X ray that has say a 10,000 to 1 chance of causing cancer, that really means one person out of 10,000 will get cancer from that one X ray. How many X rays do we get in a lifetime today ? Again, I lost track. Do the new TV's today still put out radiation ? I know the old tube TV's did and almost all of us have sat close to the TV sets in the past. Then we got the air that we breathe today, it has to be much dirtier then the air was in the 1700's That oldest age of 122 might stand longer then we can ever guess right now, IMO
Paul
Mon, Aug 12, 2013 : 11:59 p.m.
Another interesting fact of the list of the worlds oldest people ever, is out of the first 100 on the list, only 7 were males, the rest all females. That has to be due to genes or even something we don't understand yet. I'm making no guesses about why it is, just thought I point it out. Google the list on Wikipedia and check it out for yourself
Paul
Mon, Aug 12, 2013 : 11:52 p.m.
No, we lived longer then age 25, George Washington made it till 67. John Adams 91, Thomas Jefferson 83, James Madison 85. Many other presidents back then still lived LONGER then many of us do today. I'm not talking accidental deaths but those due to just old age. Sure, if you get injured today, you are much better off but we aren't all living past 100 even with our "advance" medical care, how come ? Are some thinks like vaccines doing longterm harm while at the same time doing short term good ? t We still don't understand how many cancers happen, yet how can we be so sure these vaccines are 100% harmless, we can't is the honest answer. (I'm in the same boat, had more vaccines then I can remember, I would love to believe they caused me no longterm harm but I'm not willing to bet on it. So far I'm OK but I'm not that old yet) Be interesting to see what happens to the list of the worlds oldest people ever in 50 more years, will that age of 122 be broken and by how much ? That is when the truth will finally start coming out, IMO
Brad
Mon, Aug 12, 2013 : 11:29 p.m.
Because he was lucky. The mean survival age in that era was like 25 vs. 75 today. That's three times longer, so something has definitely changed.
Paul
Mon, Aug 12, 2013 : 11:12 p.m.
Huh, what if BOTH can be unhealthy ? How come Ben Franklin who was born over 300 years ago, still lived to a ripe old age of 82 years and 300 years ago there was like no health care what so ever ?
obviouscomment
Mon, Aug 12, 2013 : 8:45 p.m.
Wow. Not really surprised though. It is such a common practice. Many women can just go to the doctor in the last couple weeks of pregnancy and say they're tired of being pregnant and get induced. It has become something done for convenience instead of emergencies. Of course these interventions are sometimes necessary, but then, and only then, should they be performed. There have been so many risks associated with being induced but too many doctors continue to down play the risks and make women think these things are necessary. In most cases they are not. Anyone pregnant or planning on having children should research all of these things carefully and not just rely on the doctor to give them information. A great documentary series is The Business Of Being Born. Check it out on Netflix or look for it in the library. Educate yourself so you can make the best decisions for your baby and your family. The idea of going to the hospital and just having a baby is more complicated than many people realize. Being pregnant and going through labor and delivery is a natural process, not a medical condition.
ThinkingOne
Tue, Aug 13, 2013 : 7:54 p.m.
Sorry, the above response should have been to a different discussion located below.
ThinkingOne
Tue, Aug 13, 2013 : 7:53 p.m.
A major factor in comparing average lifespan from 300 years ago to now is the dramatic shift in infant deaths. It takes a lot of people living a long life to counter-balance a significant number of children dying before age 2. Also, speaking of Ben Franklin, as someone else mentioned the life span of the upper class was notable longer than the lower classes. And don't get carried away by the short average life-spans of years ago. It is in our constitution that you must be at least 35 years old to become president. If there weren't a significant number of people that age or older, that requirement would rather short-sighted.
Tano
Tue, Aug 13, 2013 : 1:33 p.m.
I don't think you quite understand the meaning of "risk" in a statistical sense. The study does NOT claim that inducing labor is "risky" in the sense of CAUSING some level of autism. There is no claim whatsoever of causation here. It may, for example, be the case that some other factor, or set of factors is causing both the need for labor inducement and subsequent autism.