Prenatal, perinatal, and neonatal factors in autism, pervasive developmental disorder-not otherwise specified, and the general population.
OBJECTIVE
To examine various pre-, peri-, and neonatal factors in autistic participants and in pervasive developmental disorder-not otherwise specified (PDD-NOS) participants and to compare the incidence of each factor to that of the normal population.


METHODS
Seventy-four participants (66 males, 8 females) were diagnosed with autism at 2.5 through 4 years of age using the most accurate and up-to-date methods, including the Diagnostic and Statistical Manual of Mental Disorders and the Autism Diagnostic Interview-Revised. At age 5, all participants were reevaluated using the Diagnostic and Statistical Manual of Mental Disorders, the Autism Diagnostic Interview-Revised, the Childhood Autism Rating Scale, and the Autism Diagnostic Observation Schedule-Revised, resulting in 61 autistic and 13 PDD-NOS participants. Twenty-eight pre-, peri-, and neonatal factors were examined in these 2 groups using both medical records and parental interviews. Incidences were compared with those of the US population as reported in the Report of Final Natality Statistics, 1995. This grand scale population group was used to closely approximate comparison to a normal, unbiased population. Results were analyzed using the binomial probability test, with a P value of <.05, constituting a significant difference in incidence. A Bonferroni correction was applied to the data to adjust for the number of factors investigated.


RESULTS
Although most of the factors showed comparable incidences between the index and control groups, several factors showed statistically significant differences. Following the Bonferroni correction, the autism group was found to have a significantly higher incidence of uterine bleeding, a lower incidence of maternal vaginal infection, and less maternal use of contraceptives during conception when compared with the general population. Similarly, the PDD-NOS group showed a higher incidence of hyperbilirubinemia when compared with the general population.


CONCLUSIONS
The results of this study support previous findings suggesting a consistent association of unfavorable events in pregnancy, delivery, and the neonatal phase and the pervasive developmental disorders. However, interpretation of the meaningfulness of these results is difficult, as the specific complications that carried the highest risk of autism and PDD-NOS represented various forms of pathologic processes with no presently apparent unifying feature. Additional studies are needed to corroborate and strengthen these associations, as well as to determine the possibility of an underlying unifying pathological process. This study's analysis of obstetric and neonatal complications in combination with the use of participants diagnosed at an early age provides some interesting concepts to consider. Perhaps future research will confirm certain pre-, peri-, and neonatal associations that could be used to generate a high-risk historical profile with which to use in conjunction with currently employed diagnostic tools. This may, in turn, help to determine the reliability of a diagnosis of autism in younger children, leading to earlier intervention and assistance for an improved outcome in long-term functionality and quality of life.
Juul-Dam
N
N
School of Medicine, University of California, San Diego, La Jolla, California, USA.
Townsend
J
J
Courchesne
E
E
D001034:Apgar Score; D001321:Autistic Disorder / Q000175:diagnosis* / Q000453:epidemiology; D001724:Birth Weight; D002659:Child Development Disorders, Pervasive / Q000175:diagnosis* / Q000453:epidemiology; D002675:Child, Preschool; D015897:Comorbidity; D000013:Congenital Abnormalities / Q000453:epidemiology; D005163:Factor Analysis, Statistical; D005260:Female; D006801:Humans; D006932:Hyperbilirubinemia / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D007744:Obstetric Labor Complications / Q000175:diagnosis / Q000453:epidemiology*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis / Q000453:epidemiology*; D012127:Respiratory Distress Syndrome, Newborn / Q000175:diagnosis / Q000453:epidemiology; D012307:Risk Factors; D012640:Seizures / Q000175:diagnosis / Q000453:epidemiology