ORIGINAL CONTRIBUTIONS |
Risk Factors for Autism: Perinatal Factors, Parental Psychiatric History, and Socioeconomic Status
1 North Atlantic Neuro-Epidemiology Alliances, Department of Epidemiology and Social Medicine, University of Aarhus, Aarhus, Denmark
2 Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
3 Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
4 Department of Epidemiology and Social Medicine, University of Aarhus, Aarhus, Denmark
5 National Centre for Register-based Research, University of Aarhus, Aarhus, Denmark
6 National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA
Reprint requests to Dr. William W. Eaton, Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, 624 North Broadway, Baltimore, MD 21205 (e-mail: weaton{at}jhsph.edu).
Research suggests that heredity and early fetal development play a causal role in autism. This case-control study explored the association between perinatal factors, parental psychiatric history, socioeconomic status, and risk of autism. The study was nested within a cohort of all children born in Denmark after 1972 and at risk of being diagnosed with autism until December 1999. Prospectively recorded data were obtained from nationwide registries in Denmark. Cases totaled 698 children with a diagnosis of autism; each case was individually matched by gender, birth year, and age to 25 controls. Analyses by conditional logistic regression produced risk ratios and 95% confidence intervals. Adjusted analyses showed that the risk of autism was associated with breech presentation (risk ratio (RR) = 1.63, 95% confidence interval (CI): 1.18, 2.26), low Apgar score at 5 minutes (RR = 1.89, 95% CI: 1.10, 3.27), gestational age at birth <35 weeks (RR = 2.45, 95% CI: 1.55, 3.86), and parental psychiatric history (schizophrenia-like psychosis: RR = 3.44, 95% CI: 1.48, 7.95; affective disorder: RR = 2.91, 95% CI: 1.65, 5.14). Analyses showed no statistically significant association between risk of autism and weight for gestational age, parity, number of antenatal visits, parental age, or socioeconomic status. Results suggest that prenatal environmental factors and parental psychopathology are associated with the risk of autism. These factors seem to act independently.
autistic disorder; fetal growth retardation; mental disorders; parturition; perinatology; pregnancy outcome
Abbreviations: ICD-8, International Classification of Diseases, Eighth Revision; ICD-10, International Classification of Diseases, Tenth Revision; IDA, Integrated Database for Longitudinal Labour Market Research; MBR, Medical Birth Register; PCR, Psychiatric Central Register
Editor's note: An invited commentary on this article appears on page 926.
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