The Maternal Obstetrics, Perinatal and Postnatal Factors Associated with Autism Spectrum Disorder in Jamaica

Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder with no well-understood etiology. Genetic factors and environmental exposures during the crucial stages of neurodevelopment may have potential role in ASD. In this study, the possible role of maternal obstetric (parity, diabetes and preeclampsia), perinatal (cesarean delivery, premature birth, and low birth weight), and postnatal (breastfeeding and its duration) factors in ASD were investigated in Jamaican children. A secondary data analysis was performed using data from the “Epidemiological Research on Autism in Jamaica (ERAJ)” study, which enrolled 343 pairs of age- and sex-matched ASD cases and typically developing controls. Conditional logistic regression analyses were used to assess the possible association of maternal obstetric, perinatal and postnatal factors with ASD while controlling for potential confounders. Additionally, interactions between the main exposures and the potential confounders were explored in relation to ASD. Matched Odds Ratios (MORs) and 95% Confidence Intervals are reported. Our findings suggest that the parish of residence may be an effect modifier for the association of maternal parity, and cesarean delivery with ASD in Jamaican children. Specifically, among children from mainly urban Kingston parish, the odds of ASD was 80% lower when mothers with parity ≥ 2 were compared to nulliparous mothers after adjusting for age of parents at child birth (adjusted MOR (95% CI): 0.20 (0.09-0.45), P \u3c0.001). Also, cesarean delivery was associated with higher odds of ASD among children from Kingston parish after adjusting for age of parents at child birth (adjusted MOR (95% CI) = 2.34 (1.19-4.61), P=0.013). Whereas these associations were not significant among children from other parishes. Additionally, although not statistically significant at 0.05 level, the association between low birth weight and ASD appeared to be different by the socioeconomic status (SES) after adjusting for age of mother at child birth (adjusted MOR (95% CI): 1.79 (0.89-3.64), P = 0.1 for low SES and 0.64 (0.30-1.36), P = 0.248 for high SES). Finally, the maternal age was found to be a possible effect modifier for the association between breastfeeding duration and ASD. Specifically, among mothers who were aged ≥ 35 years, the association between breastfeeding duration and ASD was marginally significant when breastfeeding for \u3e3-6, \u3e6-12, and \u3e12 months were compared to 0-3 months of breastfeeding (MOR (95%CI): 0.30 (0.09-1.09), P = 0.067; 0.44 (0.14-1.38), P = 0.159); and 0.35 (0.11-1.12), P = 0.076, respectively). Findings of this study suggest that the association of maternal, perinatal, and postnatal characteristics with ASD may vary by the area of residence and sociodemographic characteristics of the families in Jamaica. These findings require replication in future studies