With another study on what does – or doesn’t – increase the risk of autism, a call for doctors to help parents put it all in perspective
This week in JAMA Pediatrics, Harvard epidemiologist Anna Sarah Oberg and colleagues report the good news that their large study of more than a million births showed no increased risk of autism with labor induction. Previous research had raised concerns that the use of oxytocin to induce labor might increase autism risk by reducing sensitivity to this crucial social-bonding hormone in the developing brain of a newborn.
In an accompanying editorial, Daniel Coury, medical director of the Autism Speaks Autism Treatment Network (ATN), called on the nation’s doctors to help parents sort through the constant flow of new research on what does or doesn’t predispose to autism during a woman’s pregnancy and delivery.
Dr. Coury also heads the department of developmental and behavioral pediatrics at Nationwide Children’s Hospital, in Columbus, Ohio. Nationwide is one of 14 Autism Speaks ATN centers across the United States and Canada.
The following is Dr. Coury’s message to the Autism Speaks community.
Over the last two decades, research has produced many theories to explain the rise in reported cases of autism. In recent years, we’ve seen increased attention to pregnancy and influences that may affect the developing the brain of the fetus. Various studies have found associations with a pregnant mother’s exposure to air pollution, gestational diabetes, antidepressant medications, assisted reproductive technologies and labor induction. Some of these studies have produced conflicting findings.
As is the way of science, when a small study raises a concern, we want to investigate further with larger, carefully controlled studies. Sometimes these larger, follow-up studies produce reassuring news – as is the case this week with the finding that using oxytocin to induce labor does not increase autism risk, as some had feared.
I have great empathy for families trying to sort out the sometimes reassuring, sometimes alarming news. We as physicians have a responsibility to help parents sort through it all.
Here are a few questions I encourage families to consider when they come to me with concerns about the latest study or studies.
How big a risk is this? This is a question I often hear when a pregnant mother has one of the risk factors being investigated. For example, she may have diabetes or take an antidepressant. If we start with the latest estimates of autism’s prevalence – 1 in 68 children – that means the overall risk for having a child who has autism is less than 2 percent.
If research shows that a given factor increases that risk by, say, 20 percent, remember that’s 20 percent of less than 2 percent. In other words, the likelihood is still greater than 98 percent that a child won’t be develop autism.
Suppose the risk factor being studied doubles the risk of autism. This would make the likelihood of autism around 3 percent. So 97 percent of pregnant women with the risk factor would have children unaffected by autism.
That still worries me. Do I have any options? As physicians, it’s our responsibility to help parents sort through health risks and options. Take for instance, a woman who is concerned because she’s taking an antidepressant that some research has associated with increased risk of autism if taken during pregnancy. She can and should review her situation with her doctor or doctors. It may be that the medicine has had a helpful, even life changing, benefit on her mood. If so, the risk to her and her baby’s health may be greater if she discontinues the medication. On the other hand, if the medication has not provided much benefit, she may want to discontinue it or consider alternatives.
Similarly, we need to counsel families considering assisted reproductive technologies to help with fertility problems. The possibility of a modest increased risk of autism is one of many other potential risks associated with these procedures. But this must be weighed against the great desire to have a child
For a situation like diabetes, we want every woman to work closely with her physicians to maintain the best possible health during her pregnancy – for many reasons, including the healthy development of her child.
Bottom line: We don’t know what causes autism, nor can we reduce the risk to zero. The same can be said of countless other medical and behavioral conditions that may be influenced by a myriad of factors during pregnancy. Every pregnancy carries risks, however small, and we want to help every family to work with their physicians to ensure the healthiest pregnancy possible.