Relationships between multiple births and autism spectrum disorders, cerebral palsy, and intellectual disabilities: Autism and developmental disabilities monitoring (ADDM) network-2002 surveillance year

Since the 1970s, the prevalence of multiple births (MBs) in the United States has increased significantly. This has been attributed, in large part, to iatrogenic MBs resulting from infertility treatments that include ovulation stimulation. A past study has indicated that children from MBs have an increased prevalence of cerebral palsy (CP). Other studies also have suggested an association between MBs and intellectual disabilities (ID) and autism spectrum disorders (ASDs); however, results have been inconsistent. From the Autism and Developmental Disabilities Monitoring (ADDM) Network, a surveillance project among several US populations, we obtained MB estimates among children born in 1994 and classified by 8 years of age as having: an ASD (n51,626 total children from 11 sites; 50 born as part of an MB); CP (n5302 total children from 3 sites; 25 born as part of an MB); or ID (n51,195 total children from 3 sites; 45 born as part of an MB). All three MB estimates were notably higher than age-adjusted expected estimates of naturally conceived MBs derived from 1971 US natality data. However, when MB estimates from the ADDM Network were compared with expected MB estimates derived from 1994 natality data for the states corresponding to the relevant ADDM Network sites, we observed no association with ASDs (observed/expected51.08 [0.78-1.38]), a moderate, but not statistically significant association with ID (observed/expected51.34 [0.95-1.73]), and a strong association with CP (observed/expected52.96 [1.80-4.12]). Further investigation of specific types of MBs (natural vs. iatrogenic) is warranted.