New study explores the relationship between preterm birth and autism spectrum disorder

January 29, 2009

Recent studies have suggested that autism spectrum disorder (ASD) may be more prevalent among children born very prematurely. The early symptoms of ASD are also associated with other conditions related to preterm births, such as cerebral palsy, which can make it difficult to correctly screen children for ASD. Because of this, researchers have begun to explore the relationship between preterm birth, cognitive and developmental impairments, and ASD. Two articles soon to be published in The Journal of Pediatrics explore this possible correlation between preterm birth and ASD.

Dr. Karl Kuban and colleagues from Boston University, Wake Forest University, and Harvard University studied 988 children born between 2002 and 2004 who participated in the ELGAN (Extremely Low Gestational Age Newborn) study, a large, multi-center study that enrolled more than 1500 infants born at least three months prematurely. They wanted to explore whether children born preterm are more likely to screen positive on the Modified Checklist for Autism in Toddlers (M-CHAT), a survey administered to a caregiver regarding a child's behavior. Pediatricians typically wait to formally diagnose ASD until after a child's third birthday. In this study, however, the caregivers of the infants completed the M-CHAT when the children were 24 months of age. The researchers found that 21% of the preterm children screened positive for ASD.

Dr. Kuban and his colleagues were also interested in learning whether a child born prematurely who had motor, visual, hearing, or cognitive impairments was more likely to screen positive on the M-CHAT. Of the 988 children, 26% had cognitive impairments, 11% had cerebral palsy, 3% had visual impairments, and 2% had hearing impairments. They also observed that nearly half of the children with cerebral palsy and more than two-thirds of the children with visual or hearing impairments screened positive. According to Dr. Kuban, "Children who are born more than three months premature appear to be twice as likely to screen positive on the M-CHAT." He notes, however, that the percentage of children who screened positive for ASD dropped to 10% when the variables of cognitive, visual, hearing, and motor impairments were removed.

In a related editorial, Dr. Neil Marlow and Dr. Samantha Johnson of University College London stress that because early identification leads to early treatment of children with ASD, screening tests are designed to over-identify children at risk. They suggest that useful knowledge may be gained by following the children as they mature to determine how many of those who initially screened positive actually develop ASD. Dr. Marlow notes that the study is valuable because "it raises our awareness of the difficulties in interpreting screening results." He cautions that further research is needed before conclusions can be drawn about the direct correlation between preterm birth and ASD.

Elsevier Health Sciences

---

---

	Preterm Birth: Causes, Consequences, and Prevention by Committee on Understanding Premature Birth and Assuring Healthy Outcomes (Author), Richard E. Behrman (Editor), Adrienne Stith Butler (Editor) The increasing prevalence of preterm birth in the United States is a complex public health problem that requires multifaceted solutions. Preterm birth is a cluster of problems with a set of overlapping factors of influence. Its causes may include individual-level behavioral and psychosocial factors, sociodemographic and neighborhood characteristics, environmental exposure, medical conditions, infertility treatments, and biological factors. Many of these factors co-occur, particularly in those who are socioeconomically disadvantaged or who are members of racial and ethnic minority groups. While advances in perinatal and neonatal care have improved survival for preterm infants, those infants who do survive have a greater risk than infants born at term for developmental disabilities, health...
	Preterm Birth: Prevention and Management by Vincenzo Berghella (Editor) Preterm birth is an increasing challenge in the developed and developing world.As we begin to understand what contributes to the likelihood of preterm birth, obstetricians and gynecologists can advise mothers and aspiring mothers on how to minimize the risks. Doctors can also monitor those patients who are likely to be at risk to increase the chances of preventing or effectively managing preterm labor.This practical book provides a clinically focused approach to the prevention and management of premature births, using the best available evidence to provide clear guidance to obstetricians, gynecologists, nurse midwives and family practitioners.   Written for an international audience, the author addresses the special issues affecting patients in the developing world, including infectious-...
	Preventing Preterm Birth: A Parent's Guide by Michael Katz (Author)
	Neurodevelopmental Outcomes of Preterm Birth: From Childhood to Adult Life by Chiara Nosarti (Editor), Robin M. Murray (Editor), Maureen Hack (Editor) The improved survival of very preterm and very low birth weight infants in recent decades has been associated with an increase in the prevalence of physical and neurodevelopmental problems. Attention is increasingly being focused on the quality of life of survivors, who are at greater risk of brain damage and consequent neurological disorders, and neuropsychological and behavioural impairments. In this volume, leading experts present a comprehensive and up-to-date perspective on research in various aspects of the long-term consequences of very preterm birth. As well as extending existing knowledge of the neurodevelopmental sequelae following very preterm birth, a shared aim of this burgeoning body of research is to identify the mechanisms underlying variations in outcome, and thus...
	ABC of Preterm Birth (ABC Series) by William McGuire (Editor), Peter Fowlie (Editor) Preterm birth is a major challenge in perinatal health care. Most perinatal deaths occur in preterm infants, and preterm birth is an important risk factor for neurological damage, including cerebral palsy. This ABC covers all the latest information on this complex and multidisciplinary area from obstetric issues to immediate care of preterm infants, respiratory complications, and how to provide support to the parents and relatives of the preterm infant.With its clear explanation and many illustrations, general practitioners, medical students, paediatricians starting their postgraduate training, nurses, and midwives will find ABC of Preterm Birth an excellent reference.
	Congenital Abnormalities and Preterm Birth Related to Maternal Illnesses During Pregnancy by Nándor Ács (Editor), Ferenc G. Bánhidy (Editor), Andrew E. Czeizel (Editor) This book provides the analysis of a uniquely large, population-based data set evaluating congenital anomalies as a consequence of maternal diseases. The possible adverse birth outcomes of babies born to mothers diagnosed with important diseases have not yet been evaluated in such a material by the same method. The greatest merit of these studies is that by analyzing their data the authors managed to identify some new previously unknown associations between maternal diseases and adverse birth outcomes. The first aim of the authors was to summarize 50 years of experiences in human teratology which may help younger experts to use them. The second objective was to show the methodological weaknesses of previous studies and to recommend the use of up-to-date methods when designing new studies....
	Management of Preterm Birth: Best Practices in Prediction, Prevention, and Treatment, An Issue of Obstetrics and Gynecology Clinics, 1e (The Clinics: Internal Medicine) by Alice Goepfert MD (Author) More than half a million babies in the US are born prematurely every year - preterm birth is the leading cause of infant mortality and those who survive may face lifelong problems.  This issue of the Obstetrics and Gynecology Clinics discusses the epidemiology, outcomes and clinical prediction of preterm birth, and offers information on various therapies.
	Caring for Your Baby and Young Child, 5th Edition: Birth to Age 5 (Shelov, Caring for your Baby and Young Child, Birth to Age 5) by American Academy Of Pediatrics (Author) The most up-to date, expert advice for mothers, fathers and care providers from the American Academcy of Pediatrics. From the most respected organization on child health comes this essential resource for all parents who want to provide the very best care for their children. Here is the one guide pediatricians routinely recommend and parents can safely trust, covering everything from preparing for childbirth to toilet training to nurturing your child’s self-esteem. Whether it’s resolving common childhood health problems or detailed instructions for coping with emergency medical situations, Caring for Your Baby and Young Child has everything you need. • Basic care from infancy through age five • Guidelines and milestones for physical, emotional, social,...
	Birth Emergency Skills Training: Manual for Out -of- Hospital Midwives by Bonnie U. Gruenberg (Author) Midwives attending childbirth in homes and birth centers seldom encounter emergencies, but when crisis occurs, lives hang in the balance! It is difficult to remain proficient in skills so seldom practiced, yet pregnant women rely on the expertise of the provider in an emergency. Birth Emergency Skills Training: Manual for Out-of-Hospital Midwives is the interface between the world of midwifery and the world of medicine. It carries the reader from the initial steps of intervention though definitive care, balancing a friendly tone and visual appeal with authoritative and clinically useful information. It is loaded with mnemonics and other memory aids, and is richly illustrated with the author's artful drawings and photography. What people are saying about the Birth Emergency Skills...
	Preterm Birth: Causes, Prevention and Treatment by Fritz Fuchs (Author), Phillip G. Stubblefield (Author)