Am J Perinatol 2017; 34(03): 295-304
DOI: 10.1055/s-0036-1597624
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Association of Perinatal Risk Factors with Autism Spectrum Disorder

Darios Getahun
1   Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
2   Department of Obstetrics and Gynecology, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey
Michael J. Fassett
3   Division of Maternal-Fetal Medicine, Department of Obstetrics-Gynecology, Kaiser Permanente Southern California, West Los Angeles, Los Angeles
Morgan R. Peltier
4   Winthrop University Hospital Research Institute, Winthrop University Hospital, Mineola, New York
5   Department of Obstetrics and Gynecology, Winthrop University Hospital, Mineola, New York
Deborah A. Wing
6   Department of Obstetrics-Gynecology, University of California, Irvine, California
Anny H. Xiang
1   Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
Vicki Chiu
1   Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
Steven J. Jacobsen
1   Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
› Author Affiliations
Further Information

Publication History

02 August 2016

15 November 2016

Publication Date:
31 January 2017 (online)


Objective To examine the association between exposures to perinatal factors and autism spectrum disorders (ASD).

Study Design A retrospective cohort study of ASD among children born in Kaiser Permanente Southern California hospitals between 1991 and 2009 (n = 594,638). Medical records were used to determine exposure to perinatal (antepartum and intrapartum) complications. ASD was diagnosed using DSM-IV criteria. Multivariable Cox regression was used to estimate hazard ratios (HRs).

Result Children with ASD were more likely to be exposed to perinatal complications (HR = 1.15, 95% confidence interval [CI]: 1.09–1.21) than neurotypical children. Children exposed to antepartum (HR = 1.22, 95% CI: 1.10–1.36) and intrapartum (HR = 1.10, 95% CI: 1.04–1.17) complications were at increased risk of ASD. The risk was even greater when both antepartum and intrapartum conditions were present (HR = 1.44, 95% CI: 1.26–1.63).

Conclusion Exposure to antepartum or intrapartum complications increases the risk of ASD in the offspring. Therefore, pregnancy complications may help identify children who could benefit from early screening and intervention for this common neurodevelopmental condition.


This study is supported by Kaiser Permanente Direct Community Benefit Funds. The opinions expressed are solely the responsibility of the authors and do not necessarily reflect the official views of the Kaiser Permanente Community Benefit Funds.

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