Pregnant women whose labors are induced appear to have a greater risk of bearing children with autism, especially if the baby is male, a large study from Duke University found. The study takes into account factors such as the mother’s age. Lindsay Gellman and Dr. Simon Gregory discuss.

Pregnant women who have procedures to induce or encourage labor might have an increased risk of bearing a child with autism, according to a new study.

Researchers at Duke University and the University of Michigan who conducted the study, published Monday in the journal JAMA Pediatrics, said it doesn't prove that induced and/or augmented labor causes autism. Instead, it suggests that a link exists between the circumstances surrounding these delivery procedures and autism diagnosis in childhood.

Labor may be induced when the health of the child or mother is at risk.

The researchers don't suggest any change in medical practices based on their findings.

Both induction and augmentation have seen a significant rise in popularity, according to the most recent numbers available from the National Vital Statistics Reports. In 2010, 23.4% of deliveries were induced, an increase from 9.5% in the early 1990s. Data from 2002, the most recent available, show 17.3% of deliveries were augmented that year; only 10.9% were in 1989.

Induction refers to the stimulation of uterine contractions before a woman goes into labor. Augmentation is increasing the strength, duration or frequency of uterine contractions once she has gone into labor.

Women should speak to a health-care professional about the risks and benefits associated with induction and augmentation, says Simon G. Gregory, lead author of the study and associate professor of medicine and medical genetics at Duke.

A woman might need her labor induced or augmented because her health or the health of the child is at risk during delivery, says Chad A. Grotegut, an obstetrician and gynecologist at Duke University Medical Center and a co-author of the study. For example, a mother with hypertension or diabetes or who is well past her due date, or a fetus with growth abnormalities, might require induction.

Some women elect to be induced even if the procedure isn't necessary, typically with the aim of delivering the baby sooner, Dr. Grotegut says.

The researchers culled records of all live births in North Carolina between 1990 and 1998. They matched hospital data from 625,042 children to corresponding school records, which indicated whether the child had a documented "exceptionality designation for autism"—meaning the child had been diagnosed with the disorder by a psychologist.

One in 88 children in the U.S. is diagnosed with an autism-spectrum disorder, which is characterized by "core deficits in social interaction, language development, and patterns of repetitive behaviors and/or restricted interests," the study said. Males are about four times as likely to be diagnosed with autism as females.

The North Carolina data showed that the percentage of mothers who had induced and/or augmented labor was higher for those whose children were later diagnosed with autism than for mothers whose offspring didn't develop the disorder. Mothers whose labor was both induced and augmented had a 23% greater risk of bearing a child with autism than mothers who had neither procedure.

Breaking the data down by the child's sex, the researchers found that male children born to mothers who were both induced and augmented were at a 35% greater risk of being diagnosed with autism compared with males whose mothers had neither procedure. Males whose mothers were augmented had a 15% greater risk of being diagnosed with autism than males whose mothers had neither procedure. Females whose mothers were augmented had an 18% greater risk compared with female controls.

The researchers said the study data was controlled to account for factors such as maternal age and certain health conditions, including diabetes. They said they lacked data on where on the autism spectrum the diagnosed children fell, paternal age and medications the mother took during pregnancy.

More research is needed to establish whether the induction and/or augmentation procedures themselves increase the risk for autism, or whether the underlying conditions that necessitate the procedures—among other genetic and environmental factors—increase the risk, say experts from Autism Speaks, an autism-advocacy organization.

A version of this article appeared August 12, 2013, on page D2 in the U.S. edition of The Wall Street Journal, with the headline: Induced Labor May Boost a Child's Risk Of Developing Autism.




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Women who fear childbirth just got something else to worry about: a recent Norwegian study found that women who were scared of giving birth ended up spending more time in labor, about 8 hours versus 6.5 for women who weren’t afraid.

According to the study’s authors, 5% to 20% of pregnant women fear giving birth. The reasons vary, from the mothers being young or never having given birth before to their having pre-existing psychological problems, a lack social support or a history of abuse or bad obstetric experiences.

The study also found that mothers who feared childbirth were also more likely than unafraid women to need an emergency C-section (11% versus 7%) or assistance with instruments such as forceps for vaginal delivery (17.0% versus 11%). Overall, about a quarter of women who feared childbirth delivered without any obstetric interventions, compared with nearly 45% of women who were not afraid.

“Fear of childbirth seems to be an increasingly important issue in obstetric care. Our finding of longer duration of labor in women who fear childbirth is a new piece in the puzzle within this intersection between psychology and obstetrics,” study author Samantha Salvesen Adams of Akershus University Hospital at the University of Oslo in Norway said in a statement.

(MORE: Patience, Mom: More Hospitals Say No to Scheduled Delivery Before 39 Weeks)

The researchers studied 2,206 women from pregnancy through childbirth. When the women were 32 weeks pregnant, the researchers assessed their fear of childbirth using a standard questionnaire. Women who scored higher than 85 were considered fearful; out of all the women, 165, or 7.5%, scored higher than 85.

The researchers then analyzed the time they spent in childbirth. Women who were afraid labored for an hour and 32 minutes longer than did other moms. Even after adjusting for other factors that affect labor, such as epidural anesthesia, induction and instrument-assisted delivery, fearful women took 47 minutes longer to deliver than women who had less apprehension about giving birth.

The authors note, however, that despite their fear, 89% scared mothers still succeeded in delivering vaginally, as they’d intended. That proportion was close to the 93% of women without fear who also succeeded.

“Generally, longer labor duration increases the risk of instrumental vaginal delivery and emergency caesarean section,” said Adams. “However, it is important to note that a large proportion of women with a fear of childbirth successfully had a vaginal delivery.”

Adams suggests that elective C-section shouldn’t be routinely recommended for fearful women, since, as the study’s findings show, they can still deliver vaginally if they wish.

(MORE: Pregnant Women Who Control their Epidural Dosage Use Less Medication)

The authors offer two theories for why women who are afraid of labor spend more time doing it. One is that they may psych themselves out. “Mental stress is associated with physiological arousal and release of stress hormones. During labor, high levels of stress hormones may weaken uterine contractility and thereby prolong labor in women with fear of childbirth,” says Adams.

Another explanation is that fear of childbirth may interfere with clear communication between the mother in labor and the obstetric staff. “Poor communication with health personnel may delay obstetric interventions,” Adams says.
“There are a number of reasons why women may develop a fear of childbirth,” said John Thorp, editor-in-chief of BJOG: An International Journal of Obstetrics and Gynaecology, the journal in which the new study is published, in a statement. “This research shows that women with fear of childbirth are more likely to need obstetric intervention and this needs to be explored further so that obstetricians and midwives can provide the appropriate support and advice.”



Read more: http://healthland.time.com/2012/06/29/why-women-who-fear-childbirth-end-up-spending-more-time-in-labor/#ixzz2aTB8uc8s