Israel Researchers Find Link Between Autism and General Anesthesia During Caesarean Births

May 20, 2019

3 min read

Autism arouses great fears among parents of babies and toddlers because so little is known about its causes and – while there are numerous subtypes along the autism spectrum and children can improve – it is not yet curable.

Now, researchers at Ben-Gurion University of the Negev and Soroka University Medical Center in Beersheba have documented how children who are exposed to general anesthesia during Caesarean section births are at higher risk of developing autism.

Their findings were just published in the journal Autism and Developmental Disorders under the title “Exposure to General Anesthesia May Contribute to the Association between Cesarean Delivery and Autism Spectrum Disorder.”  

“We have known for many years that children born via C-section are at higher risk of autism, but we weren’t able to quantify exactly why,” says Dr. Idan Menashe, from BGU’s department of public health and the Zlotowski Center for Neuroscience.

“The current research shows that the exposure to general anesthesia commonly used to perform a Caesarian section, rather than the operation itself, is related to communication challenges later in life. This is important because our findings highlight the potential reason for the association between c-section and autism for many years and suggest that C-sections performed with other types of anesthesia such as epidural or spinal sedation are relatively safe,” explained Menashe, who also serves as the scientific director of BGU’s National Autism Research Center.

Last year, the US Centers for Disease Control announced that one in 59 children is diagnosed with an autism spectrum disorder (ASD). Boys are four times more likely to be diagnosed with autism than girls. Although the condition characterized by challenges with social skills, repetitive behaviors, speech, and nonverbal communication can be reliably diagnosed as early as 18 months, in most countries, parents receive the diagnosis after age four.

Almost a third of children with ASD have an intellectual disability (IQ of less than 70); 25% are in the borderline range (IQ 71–85); and 44% have IQ scores in the average to above average range. Because autism is a spectrum disorder, each individual has a distinct set of strengths and challenges. The ways in which people with autism learn think and problem-solve can range from highly skilled to severely challenged. Some people with ASD may require significant support in their daily lives, while others may need less support and, in some cases, live entirely independently.

Several factors may influence the development of autism, and it is often accompanied by sensory sensitivities and medical issues such as gastrointestinal disorders, seizures or sleep disorders, as well as mental health challenges such as anxiety, depression and attention issues. 

The study, conducted by an interdisciplinary team from the National Autism Research Center at BGU and headed by Menashe, compared the births records of 350 children with autism and 2,000 healthy controls. They found that birth by C-section that was conducted with general anesthesia increases the risk of autism, while those performed with epidural or spinal (regional) anesthesia did not.

Their analysis of the records further showed that the risk of autism associated with general anesthesia is not related to the original reason for the surgery – whether it was by choice or because of medical complication. “We show that only CS performed with general anesthesia elevated the risk of ASD with no significant difference between indicated and non-indicated surgeries. We, therefore, suggest that exposure to [general anesthesia] during CS may explain the association between C-section and ASD,” Menashe explained.

Disturbingly, the team also found that the association between an infant’s exposure to general anesthesia and the development of ASD is particularly evident in relation to the most severe type of autism.

The team, besides Menashe, also included Maayan Huberman Samuel, Gal Meiri, Ilan Dinstein, Hagit Flusser, Analiya Michaelovski and Asher Bashiri.

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