Objective. To identify pre-, peri- and neonatal risk factors for pervasive developmental disorders (PDD). Methods. We searched the Medline database through March 2011 for relevant case–control and population-based studies on pre-, peri- and neonatal hazards related to PDD, including autism. We identified 85 studies for this review. Data were extracted systematically and organized according to risk factors related to family history, pregnancy, gestational age, delivery, birth milestones and the neonate's condition at birth. Results. During the prenatal period, risk factors for PDD were advanced maternal or paternal ages, being firstborn vs. third or later, maternal prenatal medication use and mother's status as foreign born. During the perinatal and neonatal periods, the risk factors for PDD were preterm birth, breech presentation, planned cesarean section, low Apgar scores, hyperbilirubinemia, birth defect and a birthweight small for gestational age. The influence of maternal pre-eclampsia, diabetes, vomiting, infections and stress during pregnancy requires further study in order to determine risk for PDD. Discussion. Despite evidence for the association of some pre-, peri- and neonatal risk factors associated with PDD, it remains unclear whether these risks are causal or play a secondary role in shaping clinical expression in individuals with genetic vulnerability. A plausible hypothsesis is that improvements in obstetric and neonatal management have led to an increased rate of survivors with pre-existing brain damage. Given the variety of risk factors, we propose that future studies should investigate combinations of multiple factors, rather than focusing on a single factor.

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Pre-, peri- and neonatal risk factors for autism

Prenatal, perinatal, and postnatal factors associated with autism: A meta-analysis.

Background: Exposure to drugs and toxins is a major cause for patients’ visits to the emergency department (ED).

Methods: Recommendations for the use of clinical laboratory tests were prepared by an expert panel of analytical toxicologists and ED physicians specializing in clinical toxicology. These recommendations were posted on the world wide web and presented in open forum at several clinical chemistry and clinical toxicology meetings.

Results: A menu of important stat serum and urine toxicology tests was prepared for clinical laboratories who provide clinical toxicology services. For drugs-of-abuse intoxication, most ED physicians do not rely on results of urine drug testing for emergent management decisions. This is in part because immunoassays, although rapid, have limitations in sensitivity and specificity and chromatographic assays, which are more definitive, are more labor-intensive. Ethyl alcohol is widely tested in the ED, and breath testing is a convenient procedure. Determinations made within the ED, however, require oversight by the clinical laboratory. Testing for toxic alcohols is needed, but rapid commercial assays are not available. The laboratory must provide stat assays for acetaminophen, salicylates, co-oximetry, cholinesterase, iron, and some therapeutic drugs, such as lithium and digoxin. Exposure to other heavy metals requires laboratory support for specimen collection but not for emergent testing.

Conclusions: Improvements are needed for immunoassays, particularly for amphetamines, benzodiazepines, opioids, and tricyclic antidepressants. Assays for new drugs of abuse must also be developed to meet changing abuse patterns. As no clinical laboratory can provide services to meet all needs, the National Academy of Clinical Biochemistry Committee recommends establishment of regional centers for specialized toxicology testing.

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National Academy of Clinical Biochemistry Laboratory Medicine Practice Guidelines: Recommendations for the Use of Laboratory Tests to Support Poisoned Patients Who Present to the Emergency Department

Background Evidence about the effect of intrauterine exposure to pre-eclampsia on offspring autism-spectrum disorder (ASD) is not well established. Aims To examine the association between pre-eclampsia and ASD. Method PubMed, Embase and PsycINFO databases were searched. Pooled relative risks (RR) with 95% confidence intervals were calculated. Subgroup and sensitivity analyses were performed. Heterogeneity was assessed using Cochran's Q- and the I 2−test. The presence of publication bias was evaluated by Egger's test and visual inspection of the symmetry in funnel plots. Results Ten studies meet the inclusion criteria. The risk of ASD was 32% higher in offspring who had intrauterine exposure to pre-eclampsia compared with those not exposed (RR = 1.32, 95% CI 1.20–1.45). Sensitivity analysis revealed consistent pooled estimates ranging from RR = 1.30 (95% CI 1.17–1.44) to RR = 1.37 (95% CI 1.26–1.48). We found no significant heterogeneity and evidence of publication bias. Conclusion Pre-eclampsia increased the risk of ASD in offspring. The finding suggests a need for early screening for ASD in offspring of women with pre-eclampsia. Declaration of interest None.

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Pre-eclampsia and the risk of autism-spectrum disorder in offspring: meta-analysis.

Safety issues are a major barrier to the use of cannabis and cannabinoid medications for clinical purposes. Information on the safety of herbal cannabis may be derived from studies of recreational cannabis use, but cannabis exposure and effects may differ widely between medical and recreational cannabis users. Standardized, quality-controlled cannabinoid products are available in Canada, and safety profiles of approved medications are available through the Canadian formulary. In the present article, the evidence behind major safety issues related to cannabis use is summarized, with the aim of promoting informed dialogue between physicians and patients in whom cannabinoid therapy is being considered. Caution is advised in interpreting these data, because clinical experience with cannabinoid use is in the early stages. There is a need for long-term safety monitoring of patients using cannabinoids for a wide variety of conditions, to further guide therapeutic decisions and public policy.

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Safety Issues Concerning the Medical Use of Cannabis and Cannabinoids

A growing trend of smoking marijuana soaked in what is purported to be embalming fluid has been reported in the literature since the mid-1980s. This article describes several cases of intoxication, gives regional epidemiological data on this phenomenon, and includes current nomenclature. The authors also analyze a sample of fluid said to be embalming fluid and discover PCP (phencyclidine) and multiple congeners and by-products of PCP manufacture. The implications of this finding are discussed, and the hypothesis that most embalming fluid-soaked marijuana likely contains PCP is considered.

Embalming fluid-soaked marijuana: new high or new guise for PCP?

To investigate the possible association of obstetric complications and autistic disorder, we performed a review of case-control studies of any obstetric complication in autistic disorder. If the odds ratio = {(Number of cases with autistic disorder with any obstetric complication)/(Number of cases with autistic disorder without any obstetric complication)}/{(Number of controls without autistic disorder with any obstetric complication)/(Number of controls without autistic disorder without any obstetric complication)} 1, then there are more complications in cases. Most publications do not provide the raw data to calculate the odds ratio. Many calculated odds ratios support the hypothesis that cases with autism have more obstetric complications. Further investigation is warranted to clarify the relationships between obstetric complications and autism and related conditions in the general population worldwide.

A Qualitative and Quantitative Review of Obstetric Complications and Autistic Disorder

Several reports have suggested an association between obstetric complications and autistic disorder. Since conclusions may be drawn from case-control studies, a methodology to identify case-control studies of autistic disorder and obstetric complications for qualitative and quantitative reviews is needed. We sought to establish the feasibility of blinding of reports as a means to remove biases in meta-analyses of case-control studies of autism and obstetric complications. Therefore, we located published reports of case-control studies of autistic disorder and obstetric complications by a literature search and additional articles. The methods or other appropriate portions of the articles were blindly reviewed for the presence or absence of obstetric complications in cases with autistic disorder matched with at least one control without autistic disorder. Good inter-rater reliability was obtained for case-control studies of autistic disorder (74.6% agreement and κ=.451) and for obstetric complications (84.0% agreement and κ=.658).

Julie A. Holland

Papers

Embalming fluid-soaked marijuana: new high or new guise for PCP?

A Qualitative and Quantitative Review of Obstetric Complications and Autistic Disorder

Reliable Classification of Case-Control Studies of Autistic Disorder and Obstetric Complications

Dangerous form of marijuana.