Abstract
BackgroundTo explore the association between cesarean section (CS) and risk of autism spectrum disorder (ASD), and evaluate the possible factors influencing this association.MethodsIn total, 950 patients diagnosed with ASD and 764 healthy controls were recruited in this study. Socio-demographic characteristics and prenatal, perinatal, and neonatal characteristics were compared between the two groups. Univariate and multivariable conditional logistic regression analyses were applied to adjust for confounders. Further stratified analyses based on sex and miscarriage history were similarly performed to explore the factors influencing the association between CS and ASD.ResultsCS was evidently associated with an elevated risk of ASD (adjusted odds ratio [aOR] = 1.606, 95% confidence interval (CI) = 1.311–1.969). Unlike regional anesthesia (RA), only CS performed under general anesthesia (GA) consistently elevated the risk of ASD (aOR = 1.887, 95% CI = 1.273–2.798) in females and males in further stratified analysis. The risk of children suffering from ASD following emergency CS was apparently increased in males (aOR = 2.390, 95% CI = 1.392–5.207), whereas a higher risk of ASD was observed among voluntary CS and indicated CS subgroups (aOR = 2.167, 95% CI = 1.094–4.291; aOR = 2.919, 95% CI = 1.789–4.765, respectively) in females. Moreover, the interaction term of CS and past miscarriage history (β = − 0.68, Wald χ2 = 7.5, df = 1, p = 0.006)) was similarly defined as influencing ASD.ConclusionsThe exposure of children to GA during CS may explain the possible/emerging association between CS and ASD. In addition, sex and miscarriage history could equally be factors influencing the association between CS and ASD.
Highlights
To explore the association between cesarean section (CS) and risk of autism spectrum disorder (ASD), and evaluate the possible factors influencing this association
After adjusting for prenatal, perinatal or neonatal confounding factors that were associated with ASD (p < 0.05) in this study (Table 3), the results indicated a significant association between CS and ASD
This study demonstrated that the correlation between CS and ASD is exclusive to CSs performed under general anesthesia (GA), with an evident heterogeneity in different surgical indications and sex
Summary
To explore the association between cesarean section (CS) and risk of autism spectrum disorder (ASD), and evaluate the possible factors influencing this association. ASD has been of general concern globally, with a substantial increase in prevalence in recent decades [2]. ASD is highly genetic [3], there is evidence suggesting the involvement of numerous prenatal and perinatal factors in its development [3,4,5,6,7]. Among all gestational and obstetric risk factors of ASD, accumulated evidence suggests an association between cesarean section (CS) and ASD which is worrisome given the dramatically increasing trend in CS implementation in numerous countries [8, 9]. A recent metaanalysis demonstrated that a 23% increase in the risk of ASD was associated with CS compared to vaginal delivery [10]. It is becoming increasingly important to fully understand the association between CS and ASD
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