title: Population attributable fractions for three perinatal risk factors for autism spectrum disorders, 2002 and 2008 autism and developmental disabilities monitoring network.
abstract: OBJECTIVE
  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.
authors: National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA. Electronic address: LSchieve@cdc.gov.
authors: Laura A
authors: LA
authors: Schieve
authors: National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA.
authors: Lin H
authors: LH
authors: Tian
authors: National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA.
authors: Jon
authors: J
authors: Baio
authors: School of Public Health, University of Illinois, Chicago.
authors: Kristin
authors: K
authors: Rankin
authors: School of Public Health, University of Illinois, Chicago.
authors: Deborah
authors: D
authors: Rosenberg
authors: National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA.
authors: Lisa
authors: L
authors: Wiggins
authors: Waisman Center, University of Wisconsin-Madison.
authors: Matthew J
authors: MJ
authors: Maenner
authors: National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA.
authors: Marshalyn
authors: M
authors: Yeargin-Allsopp
authors: Waisman Center, University of Wisconsin-Madison.
authors: Maureen
authors: M
authors: Durkin
authors: National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA.
authors: Catherine
authors: C
authors: Rice
authors: Medical University of South Carolina, Charleston.
authors: Lydia
authors: L
authors: King
authors: School of Public Health, University of South Florida, Tampa.
authors: Russell S
authors: RS
authors: Kirby
authors: College of Public Health, University of Alabama-Birmingham.
authors: Martha S
authors: MS
authors: Wingate
authors: National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA.
authors: Owen
authors: O
authors: Devine
mesh_terms: D000328:Adult; D001724:Birth Weight; D002585:Cesarean Section; D002659:Child Development Disorders, Pervasive / Q000209:etiology*; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D018743:Perinatal Care; D011159:Population Surveillance; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology; D047928:Premature Birth; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D055815:Young Adult
keywords: Autism; Birth weight; Cesarean section; Population; Premature birth; Risk factors