In The Politics of Autism, I discuss various ideas about what causes the condition. Here is just a partial list of correlates, risk factors, and possible causes that have been the subject of serious studies:
- Pesticides;
- Air pollution and proximity to freeways;
- Maternal thyroid issues;
- Autoimmune disorders;
- Induced labor;
- Preterm birth;
- Fever;
- Birth by cesarean section;
- Anesthesia during cesarean sections;
- Maternal and paternal obesity;
- Maternal diabetes;
- Maternal and paternal age;
- Maternal post-traumatic stress disorder;
- Smoking during pregnancy;
- Antidepressant use during pregnancy;
- Polycystic ovary syndrome;
- Infant opioid withdrawal;
- Zinc deficiency;
- Processed foods;
- Maternal occupational exposure to solvents;
- Estrogen in the womb;
- Morning sickness;
- Sulfate deficiency.
OBJECTIVES: There has long been an association between congenital heart disease (CHD) and general neurodevelopmental delays. However, the association between CHD and autism spectrum disorders (AuSDs) is less well understood. Using administrative data, we sought to determine the association between CHD and AuSD and identify specific CHD lesions with higher odds of developing AuSD.
METHODS: We performed a 1:3 case-control study of children enrolled in the US Military Health System from 2001 to 2013. Children with International Classification of Disease, Ninth Revision, Clinical Modification codes for AuSD were identified as cases and matched with controls on the basis of date of birth, sex, and enrollment time frame. Each child’s records were reviewed for CHD lesions and associated procedures. Conditional logistic regression determined odds ratios (ORs) and 95% confidence intervals (CIs) for comparative associations.
RESULTS: There were 8760 cases with AuSD and 26 280 controls included in the study. After adjustment for genetic syndrome, maternal age, gestational diabetes, short gestation, newborn epilepsy, birth asphyxia, and low birth weight, there were increased odds of AuSD in patients with CHD (OR 1.32; 95% CI 1.10–1.59). Specific lesions with significant OR included atrial septal defects (n = 82; OR 1.72; 95% CI 1.07–2.74) and ventricular septal defects (n = 193; OR 1.65; 95% CI 1.21–2.25).
CONCLUSIONS: Children with CHD have increased odds of developing AuSD. Specific lesions associated with increased risk include atrial septal defects and ventricular septal defects. These findings will be useful for counseling parents of children with CHD.
