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Advanced maternal age
is linked to a significantly elevated risk of
having a child with autism, regardless of the
father's age, according to an exhaustive study
of all births in California during the 1990s by
UC Davis Health System researchers. Advanced
paternal age is associated with elevated autism
risk only when the father is older and the
mother is under 30, the study found.
Published online in the
February issue of the journal
Autism Research,
the study, is one of the
largest population-based studies to quantify how
each parent's age -- separately and together --
affects the risk of having a child with autism.
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The study found that the
incremental risk of having a child with autism increased
by 18 percent -- nearly one fifth -- for every five-year
increase in the mother's age. A 40-year-old woman's risk
of having a child later diagnosed with autism was 50
percent greater than that of a woman between 25 and 29
years old.
Advanced parental age is a
known risk factor for having a child with autism.
However, previous research has shown contradictory
results regarding whether it is the mother, the father
or both who contribute most to the increased risk of
autism. For example, one study reported that fathers
over 40 were six times more likely than fathers under 30
to have a child with autism.
"This study challenges a
current theory in autism epidemiology that identifies
the father's age as a key factor in increasing the risk
of having a child with autism," said Janie Shelton, the
study's lead author and a doctoral student in the UC
Davis Department of Public Health Sciences. "It shows
that while maternal age consistently increases the risk
of autism, the father's age only contributes an
increased risk when the father is older and the mother
is under 30 years old. Among mothers over 30, increases
in the father's age do not appear to further increase
the risk of autism."
Autism is a pervasive
developmental disorder of deficits in social skills and
communication, as well as repetitive and restricted
behaviors, with onset occurring prior to age 3. Abnormal
brain development, probably beginning in the womb, is
known to be fundamental to the behaviors that
characterize autism. Current estimates place the
incidence of autism at between 1 in 100 and 1 in 110
children in the United States.
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During the 1990s, the number
of California women over 40 giving birth increased by
more than 300 percent. But only about 5 percent of the
600-percent increase in the number of autism cases in
the state can be attributed to women waiting longer to
have children, the study suggests.
To conduct their
investigation, the researchers obtained the electronic
records for all births in California between Jan. 1,
1990 and Dec. 31, 1999. The records incorporated
detailed demographic information, including the ages of
both parents. To identify which children would develop
autism, the researchers obtained electronic records
identifying children born during the study period who
later received an autism diagnosis from state Department
of Developmental Services. In this study autism was
defined as a diagnosis of full-syndrome autism at a
California Regional Center.
The researchers also excluded
a small number of births where demographic information
about parents, such as their ages and levels of
education, was not available. Instances of multiple
births were analyzed separately. The exclusions brought
the total size of the study sample to approximately 4.9
million births and 12,159 cases of autism.
For older mothers, the
step-wise progression in the risk of having a child who
later would be diagnosed with autism was apparent among
every age group of fathers. When the father was older
and the mother was younger -- under 30 -- the child's
risk for developing autism also was elevated. For
example, among births to mothers under 25, children
fathered by a man over 40 were twice as likely to
develop autism as those whose father was between 25 and
29. Among mothers over 30, the increased risk associated
with older fathers dissipated, the study found.
Because of the large study
size, the researchers were able to show how risk for
autism was affected by each parent's age by holding one
parent's age constant and then comparing autism
incidence across the age of the other parent across
five-year increments. The subtle interaction of how each
parent's age affects the risk of autism then became
quantifiable even when it was reliant on the other
parent's age. This methodology is more efficacious and
requires fewer assumptions than the mathematical
modeling used by earlier studies, the researchers said.
The researchers note that
understanding the relationship between increased
parental age and autism risk is critical to
understanding its biological causes. Earlier studies
have observed that advanced maternal age is a risk
factor for a variety of other birth-related conditions,
including infertility, early fetal loss, low
birth-weight, chromosomal aberrations and congenital
anomalies.
Irva Hertz-Picciotto,
professor of public health sciences, a researcher at the
UC Davis MIND Institute and the study's senior author,
said the reason that having an older parent places a
child at risk for autism is not known.
"We still need to out what it
is about older parents that puts their children at
greater risk for autism and other adverse outcomes, so
that we can begin to design interventions," Hertz-Picciotto
said.
One possible clue comes from a
2008 UC Davis study that found some mothers of children
with autism had antibodies to fetal brain protein, while
none of the mothers of typical children did. Advancing
age has been associated with an increase in autoantibody
production. Further work investigating advancing age in
such findings may be useful, the study authors said.
They added that some persistent environmental chemicals
accumulate in the body and also may have a role to play
in autism, possibly contributing to the apparent effect
of parental age.
The study also suggests that
epigenetic changes over time "may enable an older parent
to transfer a multitude of molecular functional
alterations to a child ... thus epigenetics may be
involved in the risks contributed by advancing parental
age as a result of changes induced by stresses from
environmental chemicals, co-morbidity or assistive
reproductive therapy."
Daniel Tancredi, an assistant
professor in the Department of Pediatrics at UC Davis
Health System, also contributed to this study. It was
funded by a grant from the National Institute of
Environmental Health Sciences; a United States
Environmental Protection Agency Science to Achieve
Results (STAR) grant; the UC Davis School of Medicine
and Office of Graduate Studies.
Journal Reference:
1. Janie F. Shelton, Daniel J. Tancredi, Irva Hertz-Picciotto.
Independent and Dependent Contributions of Advanced
Maternal and Paternal Ages to Autism Risk. Autism
Research, February 2010
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