Assessment & Research

Use of birth certificates to examine maternal occupational exposures and autism spectrum disorders in offspring.

Windham et al. (2013) · Autism research : official journal of the International Society for Autism Research 2013
★ The Verdict

Moms exposed to exhaust or disinfectants at work may double their child’s autism odds—ask about job history during intake.

✓ Read this if BCBAs who take developmental histories or consult with expectant families.
✗ Skip if Clinicians focused only on post-diagnosis skill building with no intake duties.

01Research in Context

01

What this study did

Peters et al. (2013) looked at birth certificates to see if moms’ jobs were linked to autism in their kids. They compared moms of children with autism to moms of children without autism. They sorted jobs by chemicals the moms might breathe or touch at work.

02

What they found

Moms of autistic children were twice as likely to work with exhaust, combustion fumes, or disinfectants. The link was strongest for these two chemical groups. Other workplace chemicals did not show the same jump in risk.

03

How this fits with other research

Li et al. (2022) extends this idea. They measured the actual chemical in children’s urine and saw more autism symptoms when levels were high. The 2013 job data and the 2022 urine data point to the same culprit: burnt-fuel chemicals.

Granieri et al. (2020) seems to disagree at first. They found no extra autism risk from maternal smoking during pregnancy. Smoking also puts combustion chemicals in the air. The difference is dose and route: smoking gives smaller, intermittent doses mostly at home, while jobs like mechanic or cleaner can give steady, heavier doses at work.

Xu et al. (2014) add maternal diabetes to the risk list. Like workplace chemicals, diabetes roughly doubles autism odds. Both papers remind us that the prenatal environment matters.

04

Why it matters

When you take a family history, ask where the mother worked while pregnant. Jobs with exhaust, diesel, or strong disinfectants deserve a flag. You can’t change the past, but you can use the info to plan early screening and targeted teaching for the child. It also gives caregivers a concrete reason to choose cleaner work settings in future pregnancies.

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Add one question to your intake form: ‘While pregnant, did you work around car exhaust, industrial fumes, or strong disinfectants?’

02At a glance

Intervention
not applicable
Design
quasi experimental
Sample size
943
Population
autism spectrum disorder
Finding
positive
Magnitude
medium

03Original abstract

The continuing rise in the prevalence of autism spectrum disorders has led to heightened interest in the role of nongenetic factors, including exogenous exposures, but little research has been conducted. To explore a possible role in autism etiology, we used data available from our prior studies to examine potential occupational exposures, as these may occur at higher levels than environmental exposures. Parental occupation was obtained from birth certificates for 284 children with autism and 659 controls, born in 1994 in the San Francisco Bay Area. Self-reported occupation and industry were coded into eight exposure/chemical groups based on potential neurotoxicity or reprotoxicity by a board-certified physician in occupational medicine and an industrial hygienist blinded to case-control status. Mothers of autistic children were twice as likely to work in occupations considered exposed (14.4%) as mothers of controls (7.2%) (adjusted odds ratio [AOR] 2.3 [95% confidence interval {CI} 1.3-4.2]). The exposure categories of the greatest frequency among case mothers were exhaust and combustion products (AOR = 12.0 [95% CI 1.4-104.6]) and disinfectants (AOR = 4.0 [95% CI 1.4-12.0]). Paternal occupational exposure was not associated with autism, potentially consistent with a direct in-utero exposure effect. There are several limitations of this hypothesis-generating study, including lack of detail on workplace and job duties, leading to possible misclassification and low proportion exposed. However, this misclassification would not be biased by case-control status and is unlikely to explain the associations we did find, suggesting that further research on exogenous exposures may yield useful etiologic clues.

Autism research : official journal of the International Society for Autism Research, 2013 · doi:10.1002/aur.1275