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Ann Epidemiol. 2014 Apr;24(4):260-6. doi: 10.1016/j.annepidem.2013.12.014. Epub 2014 Jan 15.

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

Author information

  • 1National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA. Electronic address: LSchieve@cdc.gov.
  • 2National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA.
  • 3School of Public Health, University of Illinois, Chicago.
  • 4Waisman Center, University of Wisconsin-Madison.
  • 5Medical University of South Carolina, Charleston.
  • 6School of Public Health, University of South Florida, Tampa.
  • 7College of Public Health, University of Alabama-Birmingham.

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.

Published by Elsevier Inc.

KEYWORDS:

Autism; Birth weight; Cesarean section; Population; Premature birth; Risk factors

PMID:
24529515
[PubMed - indexed for MEDLINE]
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