Written by Dr. John Carosso
What was that all about?
You remember the recent headline, based on a study from JAMA Pediatrics (August 12, 2013), claiming a link between induced and augmented labor and the child later receiving an autism-related special education services down the road. The study looked at birth records from ’90 to ’98, and subsequent educational records from ’97 to ’07.
So what’s the problem?
Emily Willingham of Forbes provides a concise and thorough breakdown of the study’s results, and accurately (in my opinion) concludes that the study, and most studies like it (my conclusion) are quite misleading for lots of reasons including that there is no proven ‘cause-effect’ relationship; only a loose correlation, and many excluded relevant factors. It should also be noted that the issue at hand is inducement and augmentation; when considering only inducement, the effect was 1.1; when adding augmentation it rose to a not especially compelling 1.27 (13% and 27%, respectively).
Factors not considered in the study included mother’s BMI pre-pregnancy, father’s age, child head circumference, specific child birth weight, mother’s insurance status, family socioeconomic status, the presence of any sibling births in the cohort, and if there was any autistic sibling(s). It would seem that these are important factors. Also, interesting, the study looked at link between autism and birth year, with the rates decreasing from 50% to 11% when comparing 1994 and 1998. Your guess is as good as mine as to what that means, but it adds further speculation to the results.
Willingham wraps-up the conclusions rather succinctly and logically, based on the data delineated in the study, she writes:
“If anything, based on earlier literature, it (the study’s results) adds a slight if only mathematical confirmation of the perception that births involving autistic children can be associated with more complications, such as the presence of meconium, gestational diabetes, and fetal distress, than births involving non-autistic children. And that points to induction and augmentation as useful in these situations, not as problematic, and certainly does not affirm them as a risk.”
In fact, one of the authors, Dr. Chad Grotegut, M.D., stated:
“This does not mean that labor induction and augmentation cause autism. It simply demonstrates an association between the two, but we don't know what’s causing this increased risk. We don’t know if it’s the mom’s medical conditions or fetal conditions that warrant labor induction or augmentation, the medications used, events that occur prior to or during labor, or something else all together that might explain the association. There are clear benefits to labor induction and augmentation for both moms and their babies. Given that we need more research to determine what is actually causing this increased risk for autism, the results from our study should not be used to change current practices in labor and delivery.”
Just Another Example
This is yet another example of the need to read and study beyond the headlines. It’s important to try to find the actual article and wait for subsequent analysis before you draw any conclusions. Also, note that many on-line news sources are paid by advertisers per ‘click’; the more clicks they can elicit from you, the more money they make. Consequently, the allure of an alarming headline, to compel you to ‘click’ and read further, is quite tempting.
Okay, enough about that for now. I hope that helped to clarify that issue.