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Poster Session 2

(588) Evaluating the Impact of Labor Induction on Autism Spectrum Disorder Risk

Thursday, January 30, 2025
4:00 PM – 6:00 PM  

    Submitting Author and Presenting Author(s)

  • Omri Zamstein, MD (he/him/his)

    Physician
    Soroka University Medical Center
    Soroka University Medical Center, HaDarom, Israel

    • Coauthor(s)

  • Tamar Wainstock, PhD (she/her/hers)

    Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
    Beer Sheva, HaDarom, Israel

  • Eyal Sheiner, MD, PhD

    Head of department of Obstetrics and Gynecology, Soroka University Medical Center
    Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
    Beer Sheva, HaDarom, Israel

Objective:

Significant effort has been dedicated in recent years to uncovering the environmental factors, particularly perinatal exposures, that contribute to the development of autism spectrum disorder (ASD). However, the overall picture remains incomplete, with many suggested associations lacking consistency. Given the frequent use of labor inductions for medical reasons as well as patient preference, we aimed to investigate their relationship with ASD development, considering synergistic factors that may influence ASD onset.

Study Design:

A population-based cohort study was conducted, focusing on singleton births. The study aimed to compare the occurrence of ASD in children, considering both hospital and community-based diagnoses, in relation to whether labor was induced (using mechanical cervical ripening or prostaglandins, with or without oxytocin) or began spontaneously. A Kaplan-Meier survival curve was employed to assess the cumulative ASD incidence, and a Cox proportional hazards model was used to account for confounders.

Results:

Among 115,081 births, 13,071 (11.4%) were labor induced, with the remainder beginning spontaneously. Pregnancy complications, such as gestational diabetes mellitus, preeclampsia or eclampsia, and non-reassuring fetal heart rate patterns, were significantly more common in the labor induction group (p< 0.001 for all). Conversely, preterm births were more prevalent in the spontaneous labor onset group (7.1% vs. 5.3%, p< 0.001; Table). During follow-up, 767 children were diagnosed with ASD: 1.0% in the labor induction group and 0.6% in the spontaneous labor onset group (p< 0.001). The Kaplan-Meier analysis showed a significantly higher cumulative hazard for ASD diagnosis in the labor induction group (log-rank p-value < 0.001; Figure). However, after adjusting for maternal, delivery, and fetal factors such as age, cesarean delivery, ethnicity, and gestational conditions, no significant association was found between labor induction and ASD risk (adjusted HR=1.21, 95% CI 0.99–1.47, p=0.063).

Conclusion:

Labor induction does not appear to be associated with an increased risk of ASD.