title: Maternal conditions and perinatal characteristics associated with autism spectrum disorder and intellectual disability.
abstract: BACKGROUND
  As well as being highly comorbid conditions, autism spectrum disorders (ASD) and intellectual disability (ID) share a number of clinically-relevant phenomena. This raises questions about similarities and overlap in diagnosis and aetiological pathways that may exist for both conditions.
  
  
  OBJECTIVE
  To examine maternal conditions and perinatal factors for children diagnosed with an ASD, with or without ID, and children with ID of unknown cause, compared with unaffected children.
  
  
  METHODS
  The study population comprised all live singleton births in Western Australia (WA) between January 1984 and December 1999 (N = 383,153). Univariate and multivariate multinomial logistic regression models were applied using a blocked modelling approach to assess the effect of maternal conditions, sociodemographic factors, labour and delivery characteristics and neonatal outcomes.
  
  
  RESULTS
  In univariate analyses mild-moderate ID was associated with pregnancy hypertension, asthma, urinary tract infection, some types of ante-partum haemorrhage, any type of preterm birth, elective C-sections, breech presentation, poor fetal growth and need for resuscitation at birth, with all factors showing an increased risk. Severe ID was positively associated with poor fetal growth and need for resuscitation, as well as any labour or delivery complication. In the multivariate analysis no maternal conditions or perinatal factors were associated with an increased risk of ASD without ID. However, pregnancy hypertension and small head circumference were associated with a reduced risk (OR = 0.64, 95% CI: 0.43, 0.94; OR = 0.58, 95% CI: 0.34, 0.96, respectively). For ASD with ID, threatened abortion before 20 weeks gestation and poor fetal growth were associated with an increased risk.
  
  
  CONCLUSIONS
  Findings show that indicators of a poor intrauterine environment are associated with an elevated risk of ID, while for ASD, and particularly ASD without ID, the associations are much weaker. As such, these findings highlight the importance of accounting for the absence or presence of ID when examining ASD, if we are to improve our understanding of the causal pathways associated with these conditions.
authors: Telethon Institute for Child Health Research, Centre for Child Health Research, University of Western Australia, Perth, Australia. amandal@ichr.uwa.edu.au
authors: Amanda T
authors: AT
authors: Langridge
authors: Emma J
authors: EJ
authors: Glasson
authors: Natasha
authors: N
authors: Nassar
authors: Peter
authors: P
authors: Jacoby
authors: Craig
authors: C
authors: Pennell
authors: Ronald
authors: R
authors: Hagan
authors: Jenny
authors: J
authors: Bourke
authors: Helen
authors: H
authors: Leonard
authors: Fiona J
authors: FJ
authors: Stanley
mesh_terms: D000328:Adult; D002659:Child Development Disorders, Pervasive / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology*; D036861:Delivery, Obstetric; D005260:Female; D005317:Fetal Growth Retardation / Q000453:epidemiology; D006801:Humans; D007231:Infant, Newborn; D008607:Intellectual Disability / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology*; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology*; D012307:Risk Factors; D012923:Social Class; D014904:Western Australia / Q000453:epidemiology; D055815:Young Adult