Population attributable fractions for three perinatal risk factors for autism spectrum disorders, 2002 and 2008 autism and developmental disabilities monitoring network

• Published in: Annals of epidemiology Vol. 24; no. 4; pp. 260 - 266
• Main Authors: Schieve, Laura A., PhD, Tian, Lin H., MD, Baio, Jon, EdS, Rankin, Kristin, PhD, Rosenberg, Deborah, PhD, Wiggins, Lisa, PhD, Maenner, Matthew J., PhD, Yeargin-Allsopp, Marshalyn, MD, Durkin, Maureen, PhD, Rice, Catherine, PhD, King, Lydia, PhD, Kirby, Russell S., PhD, Wingate, Martha S., DrPH, Devine, Owen, PhD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-04-2014
• Subjects: Adult; Autism; Birth Weight; Cesarean Section; Child Development Disorders, Pervasive - etiology; Female; Gestational Age; Humans; Infant, Newborn; Internal Medicine; Male; Perinatal Care; Population; Population Surveillance; Pregnancy; Pregnancy Outcome - epidemiology; Premature Birth; Risk Factors; United States - epidemiology; Young Adult; United States; Autism; Population; Birth weight; Premature birth; Cesarean section; Risk factors
• ISSN: 1047-2797; 1873-2585
• DOI: 10.1016/j.annepidem.2013.12.014

Abstract Purpose Numerous studies establish associations between adverse perinatal outcomes/complications and autism spectrum disorder (ASD). There has been little assessment of population attributable fractions (PAFs). Methods We estimated average ASD PAFs for preterm birth (PTB), small for gestational age (SGA), and Cesarean delivery (CD) in a U.S. population. Average PAF methodology accounts for risk factor co-occurrence. ASD cases were singleton non-Hispanic white, non-Hispanic black, and Hispanic children born in 1994 ( n  = 703) or 2000 ( n  = 1339) who resided in 48 U.S. counties included within eight Autism and Developmental Disabilities Monitoring Network sites. Cases were matched on birth year, sex, and maternal county of residence, race-ethnicity, age, and education to 20 controls from U.S. natality files. Results For the 1994 cohort, average PAFs were 4.2%, 0.9%, and 7.9% for PTB, SGA, and CD, respectively. The summary PAF was 13.0% (1.7%–19.5%). For the 2000 cohort, average PAFs were 2.0%, 3.1%, and 6.7% for PTB, SGA, and CD, respectively, with a summary PAF of 11.8% (7.5%–15.9%). Conclusions Three perinatal risk factors notably contribute to ASD risk in a U.S. population. Because each factor represents multiple etiologic pathways, PAF estimates are best interpreted as the proportion of ASD attributable to having a suboptimal perinatal environment resulting in PTB, SGA, and/or CD.