背景:婴儿分娩时的表现可能是发育差异的早期指标。非顶点表现(畸形)使分娩复杂化,并经常导致剖腹产,这与神经发育迟缓有关,包括自闭症谱系障碍(ASD)。然而,口蹄疫可能是现有发育问题的早期征兆,也是剖腹产的上游因素。很少有研究来调查不良与ASD之间的关系。
目的:我们研究了分娩时出现不良与ASD之间的关联,以及这种关联是否因胎龄而异。
方法:我们使用研究数据探索早期发育(SEED),一个多站点,ASD儿童与人群对照的病例对照研究。胎儿的表现是根据医疗记录确定的,出生记录和产妇访谈。我们将演示不良定义为交付时的非顶点演示,然后进一步分类为臀位和其他虐待。我们使用多变量逻辑回归估计异常和ASD之间的关联的调整比值比(aOR)。
结果:我们包括4047名种子参与者,1873名ASD儿童和2174名对照者。交货时,大多数婴儿出现顶点(n=3760,92.9%)。在调整了产妇年龄后,不良表现与较高的ASD几率相关(aOR1.31,95%置信区间[CI]1.02,1.68),贫困水平,高血压和吸烟。臀位和其他类型的畸形的相关性相似(分别为aOR1.28,95%CI0.97,1.70和aOR1.40,95%CI0.87,2.26),并且在胎龄之间没有显着差异。
结论:分娩时出现不良与ASD有一定的相关性。早期监测出生不良儿童的神经发育可以更快地识别出患有ASD的儿童,并增加提供支持以优化发育结果的机会。
BACKGROUND: An infant\'s presentation at delivery may be an early indicator of developmental differences. Non-vertex presentation (malpresentation) complicates delivery and often leads to caesarean section, which has been associated with neurodevelopmental delays, including autism spectrum disorder (ASD). However, malpresentation could be an early sign of an existing developmental problem that is also an upstream factor from caesarean delivery. Little research has been done to investigate the association between malpresentation and ASD.
OBJECTIVE: We examine the association between malpresentation at delivery and ASD and whether this association differs by gestational age.
METHODS: We used data from the
Study to Explore Early Development (SEED), a multi-site, case-control
study of children with ASD compared to population controls. The foetal presentation was determined using medical records, birth records and maternal interviews. We defined malpresentation as a non-vertex presentation at delivery, then further categorised into
breech and other malpresentation. We used multivariable logistic regression to estimate the adjusted odds ratio (aOR) for the association between malpresentation and ASD.
RESULTS: We included 4047 SEED participants, 1873 children with ASD and 2174 controls. At delivery, most infants presented vertex (n = 3760, 92.9%). Malpresentation was associated with higher odds of ASD (aOR 1.31, 95% confidence interval [CI] 1.02, 1.68) after adjustment for maternal age, poverty level, hypertensive disorder and smoking. The association was similar for
breech and other types of malpresentation (aOR 1.28, 95% CI 0.97, 1.70 and aOR 1.40, 95% CI 0.87, 2.26, respectively) and did not differ markedly by gestational age.
CONCLUSIONS: Malpresentation at delivery was modestly associated with ASD. Early monitoring of the neurodevelopment of children born with malpresentation could identify children with ASD sooner and enhance opportunities to provide support to optimise developmental outcomes.