Birth Complications and Autism

Many birthing complications appear to be risk factors for the later development of autism. An epidemiological study from Harvard University reviewing 40 studies from the literature pooled together what were the significant risk factors (Gardener et al., 2011):

* abnormal birth presentations (e.g. breech),
* umbilical-cord complications (e.g. cord wrapped around neck),
* fetal distress,
* birth injury or trauma,
* multiple birth (twins, triplets, etc.),
* maternal bleeding,
* summer birth (possibly associated with pregnancy during winter flu season),
* low birth weight or small for gestational age,
* physical birth defects,
* low 5-minute Apgar score (a rating of overall newborn health),
* meconium aspiration,
* feeding difficulties,
* newborn anemia or hyperbilirubinemia.

Factors not associated with being an autism risk included anesthesia, assisted vaginal delivery, postterm birth, high birth weight, and head circumference.

Many of these complications may happen together and may prove to be additive, especially when both antepartum and intrapartum conditions are present (Getahun et al., 2017).  In some cases the complications may be the result of medical intervention, e.g., when labor doesn’t start on its own, a physician or midwife may use techniques to induce contractions and accelerate labor while trying to achieve vaginal birth.  The drug Pitocin (a synthetic version of oxytocin) has been used for this purpose.  A recent survey study concluded that there was, “…a synergistic effect between administration of labor and delivery drugs and experiencing a birth complication, in which both obstetrics factors occurring together increased the likelihood of the fetus developing ASD later in life (p=0.003)” (Smallwood et al., 2016).  Other studies have only found a modest gender biased correlation (primarily affecting males) (Weisman et al., 2015).  Taking into account the benefits of induced labor, caution is warranted when interpreting the findings.

The large number of assembled complications offer a confound to those individuals that propose genes as the primary determinant of autism risk.  It also calls into question Neurodiversity proponents who claim that autism is a normal variation of the human genome. The aforementioned complications have in-common lack of oxygen supply to the brain.  Not getting enough oxygen to the brain is extremely dangerous to infants as well as full grown adults.  Without oxygen, cells die and the brain gets damaged resulting in cerebral palsy, developmental disorders and neurological disabilities.  Indeed, individuals with an autism spectrum disorder who had a poor intrauterine environment may concomitantly manifest intellectual disability, often severe (Langridge et al., 2013).

A technical weakness of the above-mentioned surveys is the difficulty involved in elucidating whether birth complications cause autism or whether autism itself leads to birth complications. In addition, many of the surveys relied on self-reports which opens the door to misclassification of medical conditions by patients (e.g., what constitutes preeclampsia). By contrast, a  positive of the above-mentioned studies is their clinical relevance. The presence of complications during labor and delivery may help identify children at risk for ASD and calls for early screening and intervention, when needed, to enhance their development.  The results also provide evidence pointing towards pregnancy and the prenatal period as critical to those changes that propitiate autism. In this regard, they firmly entrench autism as a neurodevelopmental disorder.


Gardener J, Spiegelman D, Buka SL. Perinatal and neonatal risk factors for autism: a comprehensive meta-analysis. Pediatrics 128(2):344-55, 2011.

Getahun D, Fassett MJ, Peltier MR, et al. Association of perinatal risk factors with autism spectrum disorders. Am J Perinatol 34(3):295-304, 2017.

Langridge AT, Glasson EJ, Nassar N, et al. Maternal conditions and perinatal characteristics associated with autism spectrum disorder and intellectual disability. PLoS 8(1): e50963, 2013.

Smallwood M, Sareen A, Baker E, et al. Increaed risk of autism development in children whose mothers experienced birth complications or received labor and delivery drugs. ASN Neuro 8(4):1759001416659742, 2016

Weisman O, Agerbo E, Carter CS, et al. Oxytocin-augmented labor and risk for autism in males. Behav Brain Res 284:207-12, 2015.

6 responses to “Birth Complications and Autism

  1. Unfortunately is not clear because all those cases are vaccinated. So this is just and excuse to avoid the real problem. I believe if doctor check the levels of heavy metals on new born and continue following those levels in the kid previous to be vaccinated the problem will be eliminated. But because they did not have any test on place and act in-discriminating following government rules, thinking that if is approved by FDA is ok to use without any precaution, that where the problem start. Several vaccine the same day will increase the load of preservative that is the real cause. I believe if you TEST before prevent diseases will resolve the problem. Make a compulsory Heavy Metals screening test from hair every 6 month in the first 6 year of life of that kid. If the level of heavy metals show in the test, stop the vaccination until older years.


    • Thank you for your comments. I am not sure however how they (or your title “autism is recoverable”) relate to the blog on birth related complications and autism. Thanks for being part of the discussion.


  2. My first two sons suffered trauma and oxygen insufficiency at birth. My second son was also badly jaundiced, and was more severely autistic than his older brother.

    In the Scientific American for October 1969, William Windle described brain damage in monkeys subjected to asphyxia at birth. Most severe was damage found in the auditory pathway of the brainstem.

    I have been trying for years to point out the significance of impaired auditory processing for language development. I wish I knew how to be heard on this matter, but my NIMH funded PhD education and research are rejected in favor of ideas put forth by Neurodiversity advocates.


  3. There were also findings a few years ago of high incidence of placental abnormalities in individuals that were later ID’d as ASD.

    Another comment I want to make, is that as someone who began studying genetics in her early 20s, I always thought of twin studies comparing concordance rates in monozygotic (identical) twins vs dizygotic (fraternal) twins as fairly “slam-dunk” technique for parsing out the relative contribution of shared genetics vs. shared environment. As the Mom of Multiples (MOM) though, having experienced the stress of a twin pregnancy, my thoughts on this have evolved. It is so absolutely rough on your body before hand (especially if you are, ahem, considered advanced maternal age), that even if you have a healthy pregnancy, the extreme exhaustion and stress is different than a typical singleton pregnancy. It is hard to describe just how truly tired you as the twin pregnancy progresses. How taking a shower means that you now need to rest for 10 minutes because it is exhausting. Post partum, even with an extremely supportive and devoted partner, if you are breastfeeding, it’s almost all on you, and juggling (physicially and figuratively) twin infants is a developmental difference that might have an influence on attachment and stress levels in the infant. There are times you cry because you just can’t comfort both babies at once, because you have to take care of the most immediate need first. A monozygotic twin pregnancy is even more complicated from the fetal health view, with twin transfusion syndrome being a major factor. The shared placenta of a monozygotic twin pair meaning a huge risk of complications. Because of the risks, there were more ultrasounds as well, and as you have blogged before, perhaps we over assume the safety of ultrasounds, especially when you are following a pregnancy so closely. All this to say, that it is no surprise that twin pregnancies, all by themselves are a risk factor for neurodevelopmental problems, and especially so, if a shared placenta is involved. This is not to say that I think MZ vs DZ concordance rates are null, it’s just that I take them with a bit of a grain of salt now. Twin pregnancy is scary, approximately 50% of births occur preterm. 50%. Many MOMs end up on bedrest due to various factors, for many, that bedrest is for weeks. Many deliver early because of twin transfusion syndrome, preeclampsia, or simply, that the babies came early. I was one of the lucky ones, carrying my twins till 38 weeks, and working the whole time.

    Liked by 2 people

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