A recent study published in JAMA Pediatrics (August 12, 2013) received national attention in the media and has caused a number of our patients to have concerns. The study examined whether labor induction (using medication to start labor) or augmentation (using medication to enhance labor once it has already started) was associated with an increased risk of autism. Over 600,000 deliveries in North Carolina from 1990-1998 were examined and matched with school records.
The authors found that children who were born after a labor that was induced or augmented had a higher chance of having a diagnosis of autism than children who were born without labor induction/augmentation. Unfortunately some of the media took this information out of context and reported that labor induction causes autism, which would some lead patients to believe that induction of labor should be avoided for this reason.
This is certainly not the case and the authors are careful to note that there are also “significant maternal and fetal benefits of labor induction including reduced fetal/neonatal death and meconium aspiration syndrome; lower cesarean section delivery rates; lower risk for neonatal ventilation, sepsis and intensive care nursery admission and reduced maternal mortality”. They also state that “our results are not sufficient to suggest altering the standard of care regarding induction or augmentation; our results do suggest that additional research is warranted”.
While the study suggests that labor induction/augmentation may be linked to autism, this study certainly does not prove that induction causes autism. It is important to understand that link between two things does not prove cause and effect, and the media is notoriously bad at pointing out this fact, as it reduces the “shock” effect of the news story. There are many factors which could account for a link between labor induction and autism. Many women being induced have underlying diseases which provide the reason for induction, and the medical problem may be the true association rather than the induction itself. For example, a link between obesity and autism, and between increased maternal age and autism, have been noted in various studies. These are both factors that increase the chance of labor induction/augmentation. It is also possible that women being induced are in environments with a higher level of medical care in general, and a higher likelihood of early diagnosis of autism. There are many factors other than the induction itself which could contribute to this association.
When evaluating TV or newspaper reporting of medical studies, it is always good to recognize that scientific studies are easy to take out of context if reduced to a one line headline or a short summary by a lay person whose job is to make a sensational sounding news article. There are many examples of news stories about medical “facts” that simply got it wrong by over-reacting to a single study, and later the information reported was found to be completely false. While we are not discounting that this study is of value and raises interesting questions about why labor induction and autism seem to be weakly linked, as always we recommend adhering to the standard of care until sufficient compelling data exists to change that standard.
All of us here at CWCC have our patients’ and their babies’ best interests at the forefront of our decision making, and we anxiously await additional research to emerge over the next few years which will hopefully shed more light on this interesting study.
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