Journal of Autism and Developmental Disorders

, Volume 49, Issue 8, pp 3127–3135 | Cite as

Exposure to General Anesthesia May Contribute to the Association between Cesarean Delivery and Autism Spectrum Disorder

  • Maayan Huberman Samuel
  • Gal Meiri
  • Ilan Dinstein
  • Hagit Flusser
  • Analiya Michaelovski
  • Asher Bashiri
  • Idan MenasheEmail author
Original Paper


Cesarean section (CS) has been consistently associated with susceptibility to autism spectrum disorder (ASD), however, the underlying mechanism for this association remains vague. Here, we studied various pre-peri-and-neonatal factors among 347 children with ASD, 117 children with other developmental delays (DD), and 2226 age, sex and ethnicity matched controls. We found that CS is significantly associated with an increased risk of ASD but not DD (p = 0.019 and p = 0.540 respectively). Furthermore, we show that only CS performed with general anesthesia (GA) elevated the risk of ASD with no significant difference between indicated and non-indicated surgeries (aOR = 1.537; 95% CI 1.026–2.302, and aOR = 1.692; 95% CI 1.057–2.709, pdiff = 0.865). We therefore suggest that exposure to GA during CS may explain the association between CS and ASD.


Autism spectrum disorder Cesarean section General anesthesia 



This research was supported by Grant No. 527/15 from the Israeli Science Foundation (ISF).

Author Contributions

MHS helped to design the study, performed the statistical analyses, and drafted the manuscript. GM participated in the design and interpretation of the data. ID participated in the design and interpretation of the data and helped in drafting the manuscript. HF participated in the design and coordination of the study. AM participated in the design and coordination of the study. AB participated in the design and interpretation of the data and helped in drafting the manuscript. IM conceived the study, guided the statistical analyses, participated in the design and interpretation of the data, and drafted the manuscript. All authors read and approved the final manuscript.

Compliance with Ethical Standards

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required. The study was approved by the SUMC institutional review board (IRB), IRB Approval Number: SOR 222-14.

Supplementary material

10803_2019_4034_MOESM1_ESM.docx (13 kb)
Supplementary material 1 (DOCX 13 kb)


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Public Health DepartmentBen-Gurion University of the NegevBeer ShevaIsrael
  2. 2.Pre-School Psychiatry UnitSoroka University Medical CenterBeer ShevaIsrael
  3. 3.Psychology DepartmentBen-Gurion University of the NegevBeer ShevaIsrael
  4. 4.Zlotowski Center for NeuroscienceBen-Gurion University of the NegevBeer ShevaIsrael
  5. 5.Child Development DepartmentSoroka University Medical CenterBeer ShevaIsrael
  6. 6.Obstetrics and Gynecology DepartmentSoroka University Medical CenterBeer ShevaIsrael

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