Autism and Covid infection during pregnancy: Guess what??
The risks of Covid infection in pregnancy unrelated to autism are sufficient to reinforce public health measures and messaging to prevent Covid infection during pregnancy – including vaccination.
We don’t need “autism risk” as a reason to prevent Covid infections during pregnancy
Headlines and news coverage have claimed that the results of a new study link Covid infections during pregnancy to having an autistic child. Yet the study, published October 30 in Obstetrics and Gynecology, actually involved an analysis on medical codes for 28 different diagnoses, only six of which fall under the autism diagnostic umbrella. [You can find those six codes here]. Only two of these autism-related codes were in the top 15 found for children in the study, and neither of them broke the top-three most commonly occurring codes.
That’s pretty stunning considering that every single headline and article covering this report highlight autism as the outcome linked to a Covid infection during pregnancy.
For this retrospective study, the researchers looked back at electronic health records data from March 2020 through May 2021. In the single Massachusetts health system the authors analyzed, they looked for a mathematical association between “any neurodevelopmental diagnosis” up to age 36 months in a child born during that time a PCR-confirmed Covid infection during the parental pregnancy. Of the more than 18,000 live births they evaluated (which means that stillbirths and miscarriages were not included), 861 people had PCR-confirmed Covid during a pregnancy. A total of 140 children resulting from these 861 pregnancies received “any neurodevelopmental diagnosis” by age 36 months. Among the 17,263 pregnancies without PCR-confirmed Covid, 1680 children received “any neurodevelopmental diagnosis.”
To identify “any neurodevelopmental diagnosis,” the authors used a list of standardized diagnostic codes to comb the records. They report that the most common diagnostic code in the data was F80.9, which is the code for “Developmental disorder of speech and language, unspecified.” Table 2 in their paper indicates that of the 140 children with “any neurodevelopmental diagnosis” after Covid exposure in utero, 82 had this diagnostic code. You can see more about this code, which includes “Speech and language development delay due to hearing loss”.
The next two most common codes were for “Expressive language disorder” and “Specific developmental disorder of motor function.” These are not autism diagnostic codes. Here's what’s included in Expressive language disorder (code F80.1) (note that it excludes pervasive developmental disorders, i.e., an autism-related diagnosis) and what’s included for “Specific developmental disorder of motor function” (F82).
Only 23 of the 140 children had a code of “autistic disorder” (F84.0), which was 2.7% of all children exposed to Covid in utero. For unexposed children, there were 190 of 1680 with this code, for a percentage of 1.1%. That’s a difference between cohorts for this diagnosis, but without a specific comparison adjusted for confounders like prematurity and low birth weight, how relevant that difference is is not clear. The authors of this study do not describe such an analysis.
Furthermore, the only other “most common” autism-related code was for “Pervasive developmental disorder, unspecified” (F84.9) Fewer than 5 children in the exposed and unexposed groups had this code in their records, for no difference between the groups. None of the other four autism-related codes were in the top-15 most commonly occurring codes.
This study was not specifically about having an autistic child, and an autism-related diagnosis was not even in the top three most common diagnoses in the children in this study.
I note that the Covid infections assessed in this study were related to the earliest Covid variants – primarily the original versions from 2020 and Delta, which blew up in May 2021. That time frame also coincides with the highest rates of severe infection and death with this virus, as the time period preceded the advent of vaccines and the buildup of some immune defense in the population.
The analysis did not bring in the health of the pregnant parent or severity of Covid infection. In fact, being born at an academic medical center was associated with increased odds that a child would receive a neurodevelopmental diagnosis. The authors say that this association may have resulted from a “referral bias for high-risk pregnancies or more comprehensive diagnostic evaluation and follow-up postnatally.” There’s far more going on here than a specific virus causing an infection.
So here are some things you can mention if anyone brings up this study:
- It did not focus only on autism. The analysis encompassed “any neurodevelopmental diagnosis” by age 36 months, and an autism diagnostic code was not even in the top three most common codes.
- Since its advent, SARS-CoV-2, the virus responsible for Covid, has been especially dangerous during pregnancy. Forget about “any neurodevelopmental condition.” This virus is reported to be associated with a 7.68-fold increased risk of mortality for the pregnant person, along with a 3.8-fold increased risk of admission to the ICU, a 15-fold increase in receipt of mechanical ventilation, a 5.5-fold increase in receipt of critical care, and a 23-fold increased risk of pneumonia. Children born after a pregnancy that involved a Covid infection have extremely increased risks for admission to neonatal ICU (1.9-fold), low birth weight (1.19-fold), and being born preterm (~2-3 fold).
- Another study of Covid infection during pregnancy found that children also have increased risk for transient hearing impairment (remember the hearing impairment code from above?) and fine motor delays.
- These broad-spectrum effects – developmental pace, motor and sensory delays, stays in the NICU, preterm birth, low birth weight – likely aren’t virus specific or autism-specific but related to the broad influence of any major infection during pregnancy.
- And according to the authors of an enormous cohort study from Sweden, an association between an infection in pregnancy and having an autistic child may have an intermediate factor connecting them: genetics. According to those authors:
Although infections in pregnant women are associated with both autism and intellectual disability in their children, the association with autism does not appear to reflect a causal relationship, but is more likely to be explained by factors shared between family members such as genetic variation or aspects of the shared environment. Thus, infection prevention is not expected to reduce autism incidence.
In summary: The risks of Covid infection in pregnancy that have nothing do to with autism are sufficient to reinforce public health measures and messaging to prevent Covid infection during pregnancy – including vaccination.
News you can use
- RFK the Lesser has reversed his claims about Tylenol and now says that the evidence linking this incredibly common, long-used over-the-counter painkiller and autism is “insufficient.” You don’t say. That might somewhat undercut the efforts of Ken Paxton, the risibly criminal attorney general for Texas, to sue makers of Tylenol on the grounds that the company should have “warned” consumers about the non-existent association of using acetaminophen during pregnancy and having an autistic child.
- Thanks to other ridiculous claims from RFK the Lesser, doctors are having to fend off parents wanting access to leucovorin, the drug that the health secretary and his cronies claim will “treat” autistic children. They find themselves in a “tough position being asked to prescribe something that is not evidence-based.”
- Speaking of painkillers and confounders between being in pain, needing painkillers while pregnant, and having an autistic child, a preprint study shows a link between fibromyalgia and having an autistic child.
- Another preprint study has indicated that administrative data in Russia/the Russian federation seriously underestimate the actual prevalence of autistic children in the region.
People you should know
- Lovette Jallow says that “disability is not a dirty word.” Writing at her personal site, she says:
But let’s be clear — autism and disability aren’t insults. They’re realities. They’re languages of access, of shared experience, of boundaries learned the hard way. If that word still makes you flinch, this essay is for you. Because every time we distance ourselves from disability, we reinforce the very structure that made distance necessary in the first place.
- In the same vein, Mark Paine, an autistic Catholic deacon, recently gave a formal address in Rome in which he said,
Over time, I learned another truth: my neurodivergence did not disqualify me; it shaped how I hear God, how I attend to people, how I linger with those on the margins. Yet too often formation asked me to become someone else rather than becoming myself in Christ. That demand wounded me and hid gifts the Church needs. … I would rather be honest and say: my autism has not been a neat gift. It has brought crippling anxiety and shame. It has exhausted me to mask. But it has also given me a certain solidarity with those who are fragile, overlooked, or fearful. If God uses my awkwardness and my honesty to welcome one person into the heart of the Church, then that is ministry.”
- Over at ElectricLit, Brian Trapp has published an interesting-looking list of books that feature the fairly uncommon combination of humor and disabled protagonists.
- Some real excitement over public transit from some real public transit enthusiasts. IYKYK
- Check out the awards video from the Autism Self-Advocacy Network’s Gala! You’ll find Nothing About Us Without Us awardee Autumn Lauener, who shared remarks:
What was buried in silence grows roots that carry us higher than those who buried us could dream for hope is a seed that dreams of forests older than itself. I cannot know, but I can hope. I can't know, but I can trust. 14:32 I cannot know, but I can choose. How do you explain universal connection to a world built on individuality? You don't. You accept it. Nothing about us without us means all of us together.
- Buckaroo and author Chuck Tingle was the recipient of the Loud Hands Award for Autistic Storytellers, who said:
And I love our shared history, and I love that these timelines have led to this moment. It's so beautiful, so moving. Thank you so much from the bottom of my heart. And let's keep trotting together and proving love. Thank you.
- The Creating Community Together Award recipients were the FEDUP collective, with a representative giving a speech. It’s a great set of speeches so give them a watch!
At TPGA
New TPGA post: These Every Day Little Things Can Destroy An Autistic Person
Bits and bobs
California has a new law, now that the state’s governor has signed a bill intended to improve access to dental care for autistic people and others with developmental and and intellectual disabilities.
Thanks for reading, and let's keep trotting together and proving love, buckaroos.
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About the Author
Dr. Emily Willingham is a 2022 MIT Knight Science Project Fellow, and the author of several books, including the upcoming If Your Adolescent Has Autism: An Essential Resource for Parents from Oxford University Press, and has served as a regular contributor to Scientific American and other national publications.