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Journal article
Optimal interpregnancy interval in autism spectrum disorder: A multi-national study of a modifiable risk factor
Autism research, v 14(11), pp 2432-2443
01 Nov 2021
PMID: 34423916
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
It is biologically plausible that risk of autism spectrum disorder (ASD) is elevated by both short and long interpregnancy intervals (IPI). We conducted a retrospective cohort study of singleton, non-nulliparous live births, 1998-2007 in Denmark, Finland, and Sweden (N = 925,523 births). Optimal IPI was defined as the IPI at which minimum risk was observed. Generalized additive models were used to estimate relative risks (RR) of ASD and 95% Confidence Intervals (CI). Population impact fractions (PIF) for ASD were estimated under scenarios for shifts in the IPI distribution. We observed that the association between ASD (N = 9302) and IPI was U-shaped for all countries. ASD risk was lowest (optimal IPI) at 35 months for all countries combined, and at 30, 33, and 39 months in Denmark, Finland, and Sweden, respectively. Fully adjusted RRs at IPIs of 6, 12, and 60 months were 1.41 (95% CI: 1.08, 1.85), 1.26 (95% CI: 1.02, 1.56), and 1.24 (95% CI: 0.98, 1.58) compared to an IPI of 35 months. Under the most conservative scenario PIFs ranged from 5% (95% CI: 1%-8%) in Denmark to 9% (95% CI: 6%-12%) in Sweden. The minimum ASD risk followed IPIs of 30-39 months across three countries. These results reflect both direct IPI effects and other, closely related social and biological pathways. If our results reflect biologically causal effects, increasing optimal IPIs and reducing their indications, such as unintended pregnancy and delayed age at first pregnancy has the potential to prevent a salient proportion of ASD cases. Lay Summary Waiting 35 months to conceive again after giving birth resulted in the least risk of autism. Shorter and longer intervals resulted in risks that were up to 50% and 85% higher, respectively. About 5% to 9% of autism cases might be avoided by optimizing birth spacing.
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- Title
- Optimal interpregnancy interval in autism spectrum disorder: A multi-national study of a modifiable risk factor
- Creators
- Gavin Pereira - Norwegian Institute of Public HealthRichard W. Francis - Telethon Kids InstituteMika Gissler - Karolinska InstituteStefan N. Hansen - Aarhus UniversityArad Kodesh - University of HaifaHelen Leonard - Curtin UniversityStephen Z. Levine - University of HaifaVera R. Mitter - Norwegian Institute of Public HealthEric T. Parner - Aarhus Univ, Dept Publ Hlth, Res Unit Biostat, Aarhus, DenmarkAnnette K. Regan - Curtin UniversityAbraham Reichenberg - Child Health and Development InstituteSven Sandin - Karolinska InstituteAuli Suominen - University of TurkuDiana Schendel - Aarhus University
- Publication Details
- Autism research, v 14(11), pp 2432-2443
- Publisher
- Wiley
- Number of pages
- 12
- Grant note
- National Institute of Environmental Health Sciences; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Institute of Environmental Health Sciences (NIEHS) National Institute of Neurological Disorders; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Institute of Neurological Disorders & Stroke (NINDS) HD073978 / Eunice Kennedy Shriver National Institute of Child Health and Human Development; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD) 1099655; 1173991 / Australian National Health and Medical Research Council (NHMRC) project; National Health and Medical Research Council of Australia 262700 / Research Council of Norway through its Centres of Excellence funding scheme 1117105 / NHMRC Senior Research Fellowship; National Health and Medical Research Council of Australia P2BEP3 191798 / Swiss National Science Foundation Early Postdoc Mobility Grant
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- A.J. Drexel Autism Institute
- Web of Science ID
- WOS:000687234400001
- Scopus ID
- 2-s2.0-85113270155
- Other Identifier
- 991019168666404721
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- Collaboration types
- Domestic collaboration
- International collaboration
- Web of Science research areas
- Behavioral Sciences
- Psychology, Developmental