A parental age at childbirth has previously been considered a possible risk factor of autism spectrum disorder.1 Reported results on the relationship between advanced parental age at child birth and autistic disorder (AD) have been inconsistent. A recent review and meta-analysis revealed a significant association between advanced parental age and AD.2,3 The accumulating data of the association does not indicate a direct causal effect, but it addresses an important public health concern. Bahrain, a developing country, showed a sharp decline in early marriage rates similar to other countries in the region. There are no epidemiological efforts locally, or regionally that address the importance of risk factors associated with AD, including advanced parental age. In this study, we aim is to examine the association of advancing parental age and childbirth order with AD. A case control design study was planned to study the relationship between advanced parental age at childbirth and childbirth order with the incidence of AD. The study received approval from the ethical committee, Ministry of Health, Bahrain, and the parents gave their informed consent prior to inclusion in the study. The study was conducted between July and December 2010. Bahrain is an archipelago situated in the Arabian Gulf, East of the Kingdom of Saudi Arabia. It covers an area approximately 750 km2, and has a population of 1.25 million, estimates for 2010. Health services are free and accessible to all residents. The country is characterized by a low infant mortality rate, 7.2 per 1,000, and high life expectancy rate of 74.8. The study population was composed of cases evaluated at the Child & Adolescent Psychiatric Unit (CAPU) of the Psychiatric Hospital, Manama, Bahrain who received a diagnosis of AD in the period of 2000-2010 (n=100). The CAPU is the only referral clinic for the diagnosis of AD in Bahrain. The unit receives referrals for all types of psychiatric disorders from all kinds of sources including families. The diagnosis was made according to the: Modified Checklist for Autism in Toddlers (M-CHAT), the American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorder (DSM IV TR), and the Childhood Autism Rating scale (CARS). A control group comprised an equal number of CAPU cases from the same time period. They were randomly selected from a pool of 350 cases, matched for age (5 years group), and gender within each group. The controls were cases of nocturnal enuresis (n=64), mild behavior disorder (n=10), and no psychopathology (n=26). The medical records from CAPU were reviewed, and related data was extracted and entered in a specially designed form. Included in the form were items such as the child’s age, gender, pregnancy, delivery, pre-natal, natal and post natal complications; stressful life events during childhood; early years of development, the child’s sleeping history, eating pattern, language development, and birth order; the parents’ age at child’s birth; parents’ education, employment, psychiatric and medical history; and the family history of AD, and consanguinity. Neither the cases nor their parents were interviewed. Parents of 9 cases and 21 controls were contacted by telephone, or home visit by the CAPU social worker to clarify missing data. Only one case from the study group was excluded due to doubtful diagnosis. The data were entered and analyzed using the Statistical Package for Social Sciences version 16.0. Chi-Square test of significance was used to assess differences when applicable. P-values 30 years at child’s birth), were 1.83 times more likely to develop AD (95% Confidence Interval [CI]: 1.02-3.28) in comparison with the reference group (mothers aged ≤30 years at child birth) in both cases and control. Children of fathers in the paternal age group (>30 years at child birth) were 2.08 times more likely to develop AD (95% CI: 1.15-3.7) in comparison with the reference group. More cases of individuals with AD were first in birth order in comparison with the control individuals, but this difference did not show any statistical significance (odds ratio 1.67, 95% CI: 0.91-3.06, p=0.095). These study results are consistent with recently reported population-based, case-cohort design studies that found an association between advanced maternal and/or paternal age and the risk of AD.4 However, our
No takes yet. Share an insight, caveat, or question.
Al-Ansari et al. (2012) studied this question.