Family History of Autism and Assisted Reproductive Technology As Risk Factors for Pregnancy Complications in the Chatterbaby Autism Risk Survey

Background: Mothers who use assisted reproductive technology (ART) are at higher risk for pregnancy and birth complications. Use of ART, family history of autism spectrum disorder (ASD), and pregnancy complications such as hypertension and abnormal bleeding have all been associated with increased risk for ASD. Given that ART pregnancies share many correlates with ASD risk factors (e.g., increased parental age, higher education level, pregnancy and birth complications), we examined whether ASD family history may be associated with an increased risk of pregnancy complications, after adjusting for ART, maternal age, and maternal education, and tested whether various ART methods showed different risk profiles for pregnancy complications.

Objectives: Examine the relationship between ASD family history, ART, and pregnancy complications, and assess whether survey participants with self-reported ASD family history had more pregnancy complications (holding constant ART, maternal age, and maternal education).

Methods: Data were collected as part of a voluntary survey completed by any user of the infant cry translation app, ChatterBaby (n = 1,782, infant age M= 91 days). The “ChatterBaby Autism Risk Survey” obtains participants’ consent for their information to be used in research, and queries demographic information, family history, and pregnancy and delivery complications (Figure 1). Of the total participants, 7.6% reported using any ART, 12.5% reported a family history of ASD, and 52.6% endorsed maternal pregnancy problems. To examine the general relationship between ART and pregnancy complications, a binomial logistic regression predicted pregnancy complications based on ART, maternal age, maternal education level, and family history of ASD. Secondary models examined specific relationships within type of ART.

Results: Pregnancy complications were significantly increased for mothers who used any ART (OR=1.66;p<0.05) and for those who had a family history of ASD (OR=1.66;p<0.001), holding constant maternal age and education (Figure 2). Mothers with a family history of ASD were not more likely to use ART (p>0.05) after holding constant maternal age and education. The relationships between maternal age, education, and pregnancy complications were specific to the nature of the complications. Different ART types showed different risk profiles for pregnancy complications. IVF, sperm donation, and embryo adoption did not result in a significantly higher risk for various pregnancy complications. However, mothers who used ICSI were more likely to experience depression requiring use of antidepressants^a; hypertension^a; preterm labor^b; cerclage, cervical incompetence or insufficiency^c; placental abruption^b; placenta accreta^a; hyperemesis gravidarium^a; treatment with opioids^b; perinatal or post-partum psychosis^c; use of anticonvulsants to treat seizures^c; intrauterine growth restriction^b; preeclampsia/eclampsia^b; and anemia^b. Mothers who used egg donation were more likely to have hypertension^a. Mothers who used IUI were more likely to have a history of miscarriage^b and experience cerclage, cervical incompetence or insufficiency^a. [Note: ^a = p<.05, ^b = p<.01, ^c = p<.001].

Conclusions: Mothers who use ART or with an ASD family history were significantly more likely to experience pregnancy complications, but mothers with ASD family history were not more likely to use ART. This suggests that ASD family history is a unique risk factor for pregnancy complications.