NDLI: Autism spectrum disorders and fetal hypoxia in a population-based cohort: Accounting for missing exposures via Estimation-Maximization algorithm

Content Provider	Springer Nature : BioMed Central
Author	Burstyn, Igor Wang, Xiaoming Yasui, Yutaka Sithole, Fortune Zwaigenbaum, Lonnie
Abstract	Background Autism spectrum disorders (ASD) are associated with complications of pregnancy that implicate fetal hypoxia (FH); the excess of ASD in male gender is poorly understood. We tested the hypothesis that risk of ASD is related to fetal hypoxia and investigated whether this effect is greater among males. Methods Provincial delivery records (PDR) identified the cohort of all 218,890 singleton live births in the province of Alberta, Canada, between 01-01-98 and 12-31-04. These were followed-up for ASD via ICD-9 diagnostic codes assigned by physician billing until 03-31-08. Maternal and obstetric risk factors, including FH determined from blood tests of acidity (pH), were extracted from PDR. The binary FH status was missing in approximately half of subjects. Assuming that characteristics of mothers and pregnancies would be correlated with FH, we used an Estimation-Maximization algorithm to estimate HF-ASD association, allowing for both missing-at-random (MAR) and specific not-missing-at-random (NMAR) mechanisms. Results Data indicated that there was excess risk of ASD among males who were hypoxic at birth, not materially affected by adjustment for potential confounding due to birth year and socio-economic status: OR 1.13, 95%CI: 0.96, 1.33 (MAR assumption). Limiting analysis to full-term males, the adjusted OR under specific NMAR assumptions spanned 95%CI of 1.0 to 1.6. Conclusion Our results are consistent with a weak effect of fetal hypoxia on risk of ASD among males. E-M algorithm is an efficient and flexible tool for modeling missing data in the studied setting.
Related Links	https://bmcmedresmethodol.biomedcentral.com/counter/pdf/10.1186/1471-2288-11-2.pdf
Ending Page	9
Page Count	9
Starting Page	1
File Format	HTM / HTML
ISSN	14712288
DOI	10.1186/1471-2288-11-2
Journal	BMC Medical Research Methodology
Issue Number	1
Volume Number	11
Language	English
Publisher	BioMed Central
Publisher Date	2011-01-05
Access Restriction	Open
Subject Keyword	Theory of Medicine Bioethics Statistical Theory and Methods Statistics for Life Sciences Medicine Health Sciences Autism Spectrum Disorder Fetal Hypoxia Neonatal Encephalopathy Perinatal Risk Factor Theory of Medicine/Bioethics
Content Type	Text
Resource Type	Article
Subject	Health Informatics Epidemiology
Journal Impact Factor	3.9/2023
5-Year Journal Impact Factor	6.5/2023

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