Clinical Epidemiology (Nov 2018)
Pregnancy outcomes in women with autism: a nationwide population-based cohort study
Abstract
Heléne EK Sundelin,1,2 Olof Stephansson,3,4 Christina M Hultman,5,6 Jonas F Ludvigsson5,7–9 1Department of Pediatrics, Faculty of Medicine and Health, Örebro University, Örebro, Sweden; 2Division of Pediatrics, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden; 3Clinical Epidemiology Unit, Department of Medicine, Solna, Karolinska University Hospital and Institutet, Stockholm, Sweden; 4Department of epidemiology and biostatistics, School of Public Health, University of California, Berkeley, CA, USA; 5Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; 6Icahn School of Medicine at Mt Sinai, New York, NY, USA; 7Department of Pediatrics, Örebro University Hospital, Örebro, Sweden; 8Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK; 9Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA Background: The consequences of autism in pregnancy outcomes have not been explored before, although it is of crucial importance because of the frequent comorbidities and medication in this group of women.Objectives: To estimate the risk of adverse pregnancy outcomes in women diagnosed with autism.Design: Nationwide population-based cohort study.Setting: Sweden.Participants: Singleton births identified in the Swedish Medical Birth Registry, 2006–2014. A total of 2,198 births to women diagnosed with autism registered in the Swedish National Patient Registry were compared to 877,742 singleton births to women without such a diagnosis.Main outcome and measures: Preterm delivery. Secondary measures were cesarean delivery (emergency and elective), Apgar score <7 at 5 minutes, small for gestational age, large for gestational age, stillbirth, gestational diabetes, and preeclampsia. ORs were calculated through logistic regression, adjusted for maternal age at delivery, maternal country of birth, smoking, maternal body mass index, parity, calendar year of birth, and psychotropic and antiepileptic medication during pregnancy.Results: Women with autism were at increased risk of preterm birth (OR=1.30; 95% CI=1.10–1.54), especially medically indicated preterm birth (OR=1.41; 95% CI=1.08–1.82), but not with spontaneous preterm birth. Maternal autism was also associated with an increased risk of elective cesarean delivery (OR=1.44; 95% CI=1.25–1.66) and preeclampsia (OR=1.34; 95% CI=1.08–1.66), but not with emergency cesarean delivery, low Apgar score (<7), large for gestational age, gestational diabetes, and stillbirth. In women with medication during pregnancy, there was no increased risk of adverse pregnancy outcome except for induction of delivery (OR=1.33; 95% CI=1.14–1.55).Conclusion and relevance: Maternal autism is associated with preterm birth, likely due to an increased frequency of medically indicated preterm births, but also with other adverse pregnancy outcomes, suggesting a need for extra surveillance during prenatal care. Keywords: autism, antiepileptic drugs, pregnancy, preeclampsia, preterm birth
