Many parents of children with autism may remember answering a long list of questions regarding their child’s early development during their autism evaluations: Was he/she premature? Were there any complications? Jaundice?  Most often these questions are asked to gather information about other possible developmental factors that may explain the symptoms. Thus, this neonatal information is usually not directly relevant to the diagnostic criteria of autism, but it is used to rule out other disorders (such as a specific genetic syndrome). So I was intrigued when I read an article published this week in the journal Pediatrics that examined the association between jaundice and a number of developmental disorders, including autism.

The authors examined practically all children born in Denmark between 1994 and 2004 using the country’s Medical Birth Register. They examined several neonatal factors, including birth weight, parental age, gestational age, parental smoking, congenital malformations, and jaundice exposure. Developmental disorder diagnoses were obtained from the country health registers and included speech and language disorders, learning disabilities, mental retardation, and autism spectrum disorders.

Among full term babies, jaundice was associated with:

- A 56% increase in the risk for speech and language disorders

- A 56% increase in the risk for autism.

Among premature babies, jaundice was not associated with a higher risk for any disorder.

A few more interesting findings:

Jaundice was associated with a risk for autism only among kids born from October to March. For these kids, jaundice increased the risk for autism by 97%. In contrast, jaundice did not increase the risk for autism among kids born from April to September. Why? The authors suggested two possibilities. One, exposure to daylight is a standard treatment for jaundice. It is possible that kids born from October to March had significantly less light exposure (remember these kids are in Denmark, which has limited daylight during winter months). It is also possible that kids born during the winter are exposed to more viruses, infections and other conditions that may be responsible for the increased risk for autism.


Jaundice increased the risk for autism only among babies born to woman having their second+ child. For these kids, jaundice increased the risk for autism by 129%. In contrast, jaundice did not increase the risk for autism in kids who were the mother’s first child. Why? The authors also offered two possible explanations. First, it is possible that mothers having their second + child have accumulated more antibodies during pregnancy that could affect development. However, it is also possible that this is a byproduct of the Danish health system. The authors explained that mothers who had a successful first pregnancy are discharged from the hospital faster during their second + pregnancies (usually the same day of delivery). This limits access to care for second-born kids with jaundice during the first days of life. In contrast, babies who are the first-born receive more extensive care and are not discharged until the 3rd or 4th day after delivery. This could result in better management of jaundice and a reduction of the risk for autism.

But the question still remains, what is the mechanism by which jaundice increases the risk for autism among these full term babies?

And finally, just to put these results into context. Jaundice affects 80% of preterm babies and 60% of full term babies. This means that the vast majority of babies who are exposed to jaundice will not develop autism.

The reference: Maimburg, R., Bech, B., Vaeth, M., Moller-Madsen, B., & Olsen, J. (2010). Neonatal Jaundice, Autism, and Other Disorders of Psychological Development PEDIATRICS, 126 (5), 872-878 DOI: 10.1542/peds.2010-0052
ResearchBlogging.org

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10 Responses to Jaundice and autism: It depends on when you’re born.

  1. Jennifer says:

    At the end of the day, neuro-behavioral disorders like autism are brain disorders. Regardless of cause (genetics, jaundice, vaccine injury, etc.), if your loved one has autism, why not start with interventions involving the brain? [advertisement redacted]

  2. Latest Autism news – Kansas senator honored for autism work | State & Regional – Wire … says:

    [...] Jaundice and autism: It depends of when you’re born. – Child … [...]

  3. Karen DeBolt says:

    This is interesting. My son did have jaundice as a baby and I was told that it was because he was having trouble latching on so he was not getting as much milk from me as he needed. Once we resolved the latching problem, the jaundice cleared right up. It was July in the Northwest US so we did not need to do anything special with lighting after leaving the hospital, but they did do a light treatment before we left. He was my third baby, and I had no trouble at all with breastfeeding my two previous babies.

    I would like to know more about what they think the mechanism of this is. Could it be just that babies with autism have feeding problems which is what causes the jaundice? Causation is so hard to sort out.

    Thanks for posting this!

  4. DSC says:

    Well, one son o’ mine had bad jaundice (he was pretty banged up as he was ready to come out an hour before they let my wife push) but, although he has social issues, he’s not autistic. Born in April.

    My autistic son was born in December, no jaundice. Both my daughters had jaundice, no autism.

    I still think something in the environment, and nothing about genetics (but epigenetics, yes), is the cause of autism. BUt what, aspartame, lead, plastics, mercury…

  5. RAJ says:

    There are four studies on neonatal jaundice and ASD risk. A previous study by the same group reported a four fold increased risk between neonatal jaundice and ASD. Juul-Dam et al reported a modest risk only in the PDD/NOS category. Croen et al found no risk between neonatal juandice and ASD risk.

    REFERENCES

    Croen LA, Yoshida CK, Odouli R, Newman TB. Neonatal hyperbilirubinemia and risk of autism spectrum disorders. Pediatrics. 2005 Feb;115(2):e135-8.

    Juul-Dam N, Townsend J, Courchesne E. Prenatal, perinatal, and neonatal factors in autism , pervasive developmental disorder-not otherwise specified, and the general population. Pediatrics; 2001;107(4) e63.

    Maimberg RD, Vaeth M, Schendel DE, Bech BH, Olsen J, et al. Neonatal jaundice: a risk factor for infantile autism? Pediatr Perinat Epidemiol. 2008 Nov;22(6):562-8.

  6. dawn says:

    My 15 month old daughter had jaundice when she was born. She was born in August and as far as we know there are no development issues. She was on the light therapy at the hospital and for a day at home. One of the reasons they were happy she was on formula was because Bilirubin count is lowered through bowel movements and urination so the more she drank, the more her levels dropped. So to the person whose baby wouldn’t latch, they weren’t getting enough to drink so the levels didn’t drop. Once they latched the levels dropped and the jaundice went away.

    I would be interested in knowing more about the deliveries of the babies with jaundice and autism. For example, were they induced? Was the mother running a fever? Were they past their due date? Other health factors of the mother.

    In some extreme jaundice cases Kernicterus can occur which is damage to the brain centers of infants caused by increased levels of unconjugated bilirubin. Perhaps that is the correlation between autism.

  7. Kevan Gelling says:

    It has been speculated that vitamin D deficiency is a risk factor for autism. Certainly, in Denmark, the period between October to March coincides with when the sun is too weak for vitamin D to be made in the skin.

    A quick trawl through PubMed shows some evidence that jaundice interferes with the liver’s ability to activate vitamin D which could be why autumn/winter jaundice and autism are linked.

    A comparison of breast fed vs bottle fed rates of the jaundiced newborns would be interesting – formula milk is supplemented with vitamin D whereas breast milk is not, so if vitamin D was a risk factor then autism rates would be higher in the breast-fed children

  8. enstjernestund says:

    My Daughter was first diagnosed with autism when she turned 21. It not so long ago, finally, or as she said “Now I understand why I,ve allways been diffrent.
    One thing is to use theese words about a handicap, another thing is for her to understand it, i doubt she ever will.
    She,s never had problems with schoolwork. What makes her life difficult is the social interaction with other people, that brings her into situations, that for her is so hard to manage, that it,s allways they other young peoples fault.
    We,re “gratefull” though that we all know what her handicap is,

  9. DSC says:

    Merry Christmas

  10. [...] Jaundice and autism: It depends of when you’re born. (child-psych.org) [...]

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