Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
BMC Pediatrics
Published in: BMC Pediatrics 1/2021

01-12-2021 | Autism Spectrum Disorder | Research article

Anesthesia, sex and miscarriage history may influence the association between cesarean delivery and autism spectrum disorder

Authors: Ye Yang, Jingjing Lin, Xiaozi Lu, Guanglei Xun, Renrong Wu, Yamin Li, Jianjun Ou, Yidong Shen, Kun Xia, Jingping Zhao

Published in: BMC Pediatrics | Issue 1/2021

Login to get access

Abstract

Background

To explore the association between cesarean section (CS) and risk of autism spectrum disorder (ASD), and evaluate the possible factors influencing this association.

Methods

In 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.

Results

CS 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.

Conclusions

The 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.
Literature
1.
Psychiatric A. Diagnostic and statistical manual of mental disorders, ffth edition (DSM-V). Arlington: American Psychiatric Publishing; 2013.
2.
Hansen SN, Schendel DE, Parner ET. Explaining the increase in the prevalence of autism spectrum disorders: the proportion attributable to changes in reporting practices. JAMA Pediatr. 2015;169(1):56–62.PubMedCrossRef
3.
4.
Saroukhani S, Samms-Vaughan M, Lee M, Bach MA, Bressler J, Hessabi M, et al. Perinatal factors associated with autism spectrum disorder in Jamaican children. J Autism Dev Disord. 2019;50(9):3341–57.
5.
Hadjkacem I, Ayadi H, Turki M, Yaich S, Khemekhem K, Walha A, et al. Prenatal, perinatal and postnatal factors associated with autism spectrum disorder. J Pediatr. 2016;92(6):595–601.CrossRef
6.
Getahun D, Fassett MJ, Peltier MR, Wing DA, Xiang AH, Chiu V, et al. Association of Perinatal Risk Factors with autism Spectrum disorder. Am J Perinatol. 2017;34(3):295–304.PubMedCrossRef
7.
Froehlich-Santino W, Londono Tobon A, Cleveland S, Torres A, Phillips J, Cohen B, et al. Prenatal and perinatal risk factors in a twin study of autism spectrum disorders. J Psychiatr Res. 2014;54:100–8.PubMedPubMedCentralCrossRef
8.
Saleh AM, Dudenhausen JW, Ahmed B. Increased rates of cesarean sections and large families: a potentially dangerous combination. J Perinat Med. 2017;45(5):517–21.PubMedCrossRef
9.
Schieve LA, Tian LH, Baio J, Rankin K, Rosenberg D, Wiggins L, et al. Population attributable fractions for three perinatal risk factors for autism spectrum disorders, 2002 and 2008 autism and developmental disabilities monitoring network. Ann Epidemiol. 2014;24(4):260–6.PubMedPubMedCentralCrossRef
10.
Curran EA, O'Neill SM, Cryan JF, Kenny LC, Dinan TG, Khashan AS, et al. Research review: birth by caesarean section and development of autism spectrum disorder and attention-deficit/hyperactivity disorder: a systematic review and meta-analysis. J Child Psychol Psychiatry. 2015;56(5):500–8.PubMedCrossRef
11.
HamadéA S, Medlej-HashimM,Hajj-MoussaE,Saadallah-ZeidanN,RizkF. Autismin children and correlates in Lebanon:apilotcase-controlstudy. J Res Health Sci. 2013;13(2):119–24.
12.
Maramara LA, He W, Ming X. Pre- and perinatal risk factors for autism spectrum disorder in a New Jersey cohort. J Child Neurol. 2014;29(12):1645–51.PubMedCrossRef
13.
14.
Huberman Samuel M, Meiri G, Dinstein I, Flusser H, Michaelovski A, Bashiri A, et al. Exposure to general anesthesia may contribute to the association between cesarean delivery and autism Spectrum disorder. J Autism Dev Disord. 2019;49(8):3127–35.PubMedCrossRef
15.
The L. Stemming the global caesarean section epidemic. Lancet. 2018;392:10155.
16.
Feng XL, Wang Y, An L, Ronsmans C. Cesarean section in the People’s Republic of China: current perspective. J Womens Health. 2014;6:59–74.
17.
Kolas T, Hofoss D, Daltveit AK, Nilsen ST, Henriksen T, Hager R, et al. Indications for cesarean deliveries in Norway. Am J Obstet Gynecol. 2003;188(4):864–70.PubMedCrossRef
18.
Barber EL, Lundsberg LS, Belanger K, Pettker CM, Funai EF, Illuzzi JL. Indications contributing to the increasing cesarean delivery rate. Obstet Gynecol. 2011;118(1):29–38.PubMedPubMedCentralCrossRef
19.
20.
Abebe Eyowas F, Negasi AK, Aynalem GE, Worku AG. Adverse birth outcome: a comparative analysis between cesarean section and vaginal delivery at Felegehiwot referral hospital, Northwest Ethiopia: a retrospective record review. Pediatr Health Med Ther. 2016;7:65–70.CrossRef
21.
Keag OE, Norman JE, Stock SJ. Long-term risks and benefits associated with cesarean delivery for mother, baby, and subsequent pregnancies: systematic review and meta-analysis. PLoS Med. 2018;15(1):e1002494.PubMedPubMedCentralCrossRef
22.
Thavagnanam S, Fleming J, Bromley A, Shields MD, Cardwell CR. A meta-analysis of the association between caesarean section and childhood asthma. Clin Exp Allergy. 2008;38(4):629–33.PubMedCrossRef
23.
24.
Alvina K, Jodeiri Farshbaf M, Mondal AK. Long term effects of stress on hippocampal function: emphasis on early life stress paradigms and potential involvement of neuropeptide Y. J Neurosci Res. 2020.
25.
26.
Sucksdorff M, Lehtonen L, Chudal R, Suominen A, Gissler M, Sourander A. Lower Apgar scores and caesarean sections are related to attention-deficit/hyperactivity disorder. Acta Paediatr. 2018;107(10):1750–8.PubMedCrossRef
27.
Curran EA, Dalman C, Kearney PM, Kenny LC, Cryan JF, Dinan TG, et al. Association between obstetric mode of delivery and autism spectrum disorder. JAMA Psychiatry. 2015;72(9):935–42.PubMedCrossRef
28.
Polo-Kantola P, Lampi KM, Hinkka-Yli-Salomaki S, Gissler M, Brown AS, Sourander A. Obstetric risk factors and autism spectrum disorders in Finland. J Pediatr. 2014;164(2):358–65.PubMedCrossRef
29.
Yip BHK, Leonard H, Stock S, Stoltenberg C, Francis RW, Gissler M, et al. Caesarean section and risk of autism across gestational age: a multi-national cohort study of 5 million births. Int J Epidemiol. 2017;46(2):429–39.PubMed
30.
Yang XJ, Sun SS. Comparison of maternal and fetal complications in elective and emergency cesarean section: a systematic review and meta-analysis. Arch Gynecol Obstet. 2017;296(3):503–12.PubMedCrossRef
31.
Chien LN, Lin HC, Shao YH, Chiou ST, Chiou HY. Risk of autism associated with general anesthesia during cesarean delivery: a population-based birth-cohort analysis. J Autism Dev Disord. 2015;45(4):932–42.PubMedCrossRef
32.
Sumikura H, Niwa H, Sato M, Nakamoto T, Asai T, Hagihira S. Rethinking general anesthesia for cesarean section. J Anesth. 2016;30(2):268–73.PubMedCrossRef
33.
Olutoye OA, Baker BW, Belfort MA, Olutoye OO. Food and Drug Administration warning on anesthesia and brain development: implications for obstetric and fetal surgery. Am J Obstet Gynecol. 2018;218(1):98–102.PubMedCrossRef
34.
DiMaggio CSL, Kakavouli A, Byrne MW, Li G. A retrospective cohort study of the association of anesthesia and hernia repair surgery with behavioral and developmental disorders in young children. J Neurosurg Anesthesiol. 2009;21:286.PubMedPubMedCentralCrossRef
35.
Wilder RT, Sprung J, Katusic SK, Barbaresi WJ, Mickelson C, Gleich SJ, et al. Early exposure to anesthesia and learning disabilities in a population-based birth cohort. Anesthesiology. 2009;110:796–804.PubMedCrossRef
36.
Small CJ, Stanley SA, Mitchell JR, Murphy K, Morgan DG, Ghatei MA, et al. Effects of chronic central nervous system administration of agouti-related protein in pair-fed animals. Diabetes. 2001;50:248–54.PubMedCrossRef
37.
Shen Y, Dong H, Lu X, Lian N, Xun G, Shi L, et al. Associations among maternal pre-pregnancy body mass index, gestational weight gain and risk of autism in the Han Chinese population. BMC Psychiatry. 2018;18(1):11.PubMedPubMedCentralCrossRef
38.
Schmitz JC, Cholemkery H, Medda J, Freitag CM. Prä- und perinatale Risikofaktoren bei Autismus-Spektrum-Störung und Aktivitäts- und Aufmerksamkeitsstörung. Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie. 2017;45(3):209–17.PubMedCrossRef
39.
Nippita TA, Lee YY, Patterson JA, Ford JB, Morris JM, Nicholl MC, et al. Variation in hospital caesarean section rates and obstetric outcomes among nulliparae at term: a population-based cohort study. BJOG Int J Obstet Gynaecol. 2015;122(5):702–11.CrossRef
40.
Castellheim A, Lundstrom S, Molin M, Kuja-Halkola R, Gillberg C, Gillberg C. The role of general anesthesia on traits of neurodevelopmental disorders in a Swedish cohort of twins. J Child Psychol Psychiatry. 2018;59(9):966–72.PubMedCrossRef
41.
Lin EP, Lee JR, Lee CS, Deng M, Loepke AW. Do anesthetics harm the developing human brain? An integrative analysis of animal and human studies. Neurotoxicol Teratol. 2017;60:117–28.PubMedCrossRef
42.
Abe H, Sumitani M, Uchida K, Ikeda T, Matsui H, Fushimi K. Association between mode of anaesthesia and severe maternal morbidity during admission for scheduled caesarean delivery: a nationwide population-based study in Japan, 2010-2013. Br J Anaesth. 2018;120(4):779–89.PubMedCrossRef
43.
Devroe S, Van de Velde M, Rex S. General anesthesia for caesarean section. Curr Opin Anaesthesiol. 2015;28(3):240–6.PubMedCrossRef
44.
Hyde MJ, Modi N. The long-term effects of birth by caesarean section: the case for a randomised controlled trial. Early Hum Dev. 2012;88(12):943–9.PubMedCrossRef
45.
Lichtman Y, Sheiner E, Wainstock T, Segal I, Landau D, Walfisch A. Maternal history of recurrent pregnancy loss is associated with increased risk for long-term pediatric gastrointestinal morbidity in the offspring. Am J Reprod Immunol. 2018;79(2):e12799.CrossRef
Metadata
Title
Anesthesia, sex and miscarriage history may influence the association between cesarean delivery and autism spectrum disorder
Authors
Ye Yang
Jingjing Lin
Xiaozi Lu
Guanglei Xun
Renrong Wu
Yamin Li
Jianjun Ou
Yidong Shen
Kun Xia
Jingping Zhao
Publication date
01-12-2021
Publisher
BioMed Central
Published in
BMC Pediatrics / Issue 1/2021
Electronic ISSN: 1471-2431
DOI
https://doi.org/10.1186/s12887-021-02518-1

Other articles of this Issue 1/2021

BMC Pediatrics 1/2021 Go to the issue

Research

Prevalence of increased transaminases and its association with sex, age, and metabolic parameters in children and adolescents with obesity – a nationwide cross-sectional cohort study

Research

Hypovitaminosis D and risk factors in pediatric epilepsy children

Research article

Clinical experience of use of percutaneous peripheral arterial cannulation in sick neonates in a developing country

Research

Optimizing parenteral nutrition to achieve an adequate weight gain according to the current guidelines in preterm infants with birth weight less than 1500 g: a prospective observational study

Research

A study of students’ use of restraint systems in school transportation services in primary and secondary schools in northern Iran: an observational study

Research article

Clinical signs associated with earlier diagnosis of children with autism Spectrum disorder