In October, a study by Gregory et al using North Carolina birth records reported a possible association between labor induction or augmentation with an increased risk for autism. Because of the increased incidence of autism and the frequency of oxytocin use in labor, this study resulted in quite a bit of both media buzz and alarm. Many, including both the authors and one recovering obstetrician, commented on the problems with this study and urged caution in interpreting the study's findings.
In the May issue of the journal Obstetrics and Gynecology, the American Congress of Obstetricians and Gynecologists (ACOG) weigh in with a Committee Opinion also endorsed by the Society for Maternal-Fetal Medicine (SMFM.)
...Although the Gregory study suggested an association between ASD and labor induction or augmentation, the study design could not determine if such findings were truly a result of cause and effect. This was recognized by the authors, who noted that interpretation of their findings was limited by missing data regarding important potential confounders, the use of education as a proxy for socioeconomic status, and a lack of data regarding induction indications and methods. They concluded that the “results are not sufficient to suggest altering the standard of care regarding induction or augmentation…though additional research is warranted” (20).
Subsequent to its publication, the Gregory study has been criticized because of limitations in defining the exposure and the outcome of interest (21). Critics note that investigators did not know the specific individual or combination of agents that were used for labor induction or augmentation. The critics also note that the American Psychiatric Association reported an editorial error in the criteria listed for the diagnosis of pervasive developmental disorder not otherwise specified in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV); an error potentially leading to overdiagnosis during much of the time covered by the Gregory study (21).
The ACOG publication concludes:
Current evidence does not identify a causal relationship between labor induction or augmentation in general, or oxytocin labor induction specifically, and autism or ASD. Recognizing the limitations of available study design, conflicting data, and the potential consequences of limiting labor induction and augmentation, the Committee on Obstetric Practice recommends against a change in current guidance regarding counseling and indications for and methods of labor induction and augmentation.
Stay tuned.
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