Numerous Confounders Affecting the Alleged Association Between Cesarean Deliveries Under General Anesthesia and Autism Spectrum Disorder

We have read with great interest the paper of Huberman Samuel et al., comparing various perinatal factors between 347 children with autism spectrum disorder (ASD), 117 children with other developmental delays (DD), and 2226 controls (Huberman Samuel et al. 2019). The authors found a significant association between cesarean delivery and ASD—adjusted Odds Ratio 1.371 (95% confidence interval 1.004–1.872), p = 0.047. When analyzed according to the type of anesthesia, the association remained significant only for cesarean deliveries performed under general anesthesia. The authors concluded that reported associations between cesarean delivery and ASD are likely due to the exposure to general anesthesia during the operation. …