Elsevier

The Journal of Pediatrics

Volume 220, May 2020, Pages 175-183.e8
The Journal of Pediatrics

Original Article
Gestational Age, Perinatal Characteristics, and Autism Spectrum Disorder: A Birth Cohort Study

https://doi.org/10.1016/j.jpeds.2020.01.022Get rights and content

Objective

To determine how gestational age relates to research-identified autism spectrum disorder (ASD-R) in the context of perinatal risk factors.

Study design

This is a population-based cohort study using the 1994-2000 Olmsted County Birth Cohort. Children included were born and remained in Olmsted County after age 3 years. ASD-R status was determined from signs and symptoms abstracted from medical and educational records. Cox proportional hazards models were fit to identify associations between perinatal characteristics and ASD-R.

Results

The incidence of preterm birth (<37 weeks' gestation) was 8.6% among 7876 children. The cumulative incidence of ASD-R was 3.8% (95% CI 3.3-4.2) at 21 years of age. Compared with children born at full term, the risk of ASD-R appeared to be increased for children born preterm with unadjusted hazard ratios (HRs) of 2.62 (95% CI 0.65-10.57), 1.68 (95% CI 0.54-5.29), and 1.60 (95% CI 1.06-2.40) for children born extremely preterm, very preterm, and moderate-to-late preterm, respectively. In a multivariable model adjusted for perinatal characteristics, the associations were attenuated with adjusted HRs of 1.75 (95% CI 0.41-7.40), 1.24 (95% CI 0.38-4.01), and 1.42 (95% CI 0.93-2.15), for children born extremely preterm, very preterm, and moderate-to-late preterm, respectively. Among children with maternal history available (N = 6851), maternal psychiatric disorder was associated with ASD-R (adjusted HR 1.73, 95% CI 1.24-2.42).

Conclusions

The increased risk of ASD-R among children born preterm relative to children born full term was attenuated by infant and maternal characteristics.

Section snippets

Methods

This is a population-based retrospective cohort study using the 1994-2000 Olmsted County Birth Cohort. Olmsted County is located in southeast Minnesota and is home to the Mayo Clinic. The cohort was identified using birth certificate data obtained from the Minnesota Department of Health and using the resources of the Rochester Epidemiology Project (REP). The REP is a medical records-linkage system that includes outpatient and inpatient records from providers in the community, including Mayo

Results

This study evaluated data from 8115 children in the 1994-2000 Olmsted County Birth Cohort who resided in Olmsted County at age 3 years (Figure 1). There were 7876 children included in the analysis after we applied the inclusion and exclusion criteria. The incidence of preterm birth (<37 weeks' gestation) was 8.6% in this cohort, which was lower than the national average (11%) for the period.30,31 Moderate-to-late preterm birth (32-36 weeks' gestation) accounted for the majority of premature

Discussion

Using an Olmsted County birth cohort of children born 1994-2000, we found multiple perinatal risk factors for ASD-R. Unadjusted analyses revealed male sex, maternal marital status, maternal education level, tobacco use during pregnancy, and inappropriately low weight gain during pregnancy to be associated with ASD-R. In the multivariable model for the full cohort, male sex, maternal age, maternal marital status, and tobacco use during pregnancy were significantly associated with ASD-R. In this

Data Statement

Data sharing statement available at www.jpeds.com.

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    This study was made possible using the resources of the Rochester Epidemiology Project with support from the National Institute on Aging (R01AG034676) and from the National Institute of Mental Health (MH093522) of the National Institutes of Health (NIH). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. The authors declare no conflicts of interest.

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