ATLANTA – Kids with congenital heart disease are 32% more likely to develop autism spectrum disorder, according to research led by Matthew Oster, MD, MPH, a Pediatric Cardiologist in the Children's Healthcare of Atlanta Heart Center. The findings, published last month in Pediatrics, may lead to earlier detection of autism in congenital heart disease patients.
“If a kid has heart defects, parents and providers should be aware they’re at a slightly higher risk for neurodevelopmental problems like autism,” said Dr. Oster, Director of Children’s Cardiac Outcomes Research Program and Associate Professor at Emory University School of Medicine. “If they do have neurodevelopmental problems, then we know to get them the services they need as quickly as possible.”
Congenital heart disease, which is when the heart fails to develop normally before birth causing abnormalities like a hole in the heart, is the most common birth defect, affecting nearly 1 in 100 kids born in the U.S. At the same time, 1 in 59 kids in the U.S. will meet the diagnostic criteria for autism by age 8.
Dr. Oster and his colleagues at Emory University and Uniform Services University of the Health Sciences conducted a retrospective case control study using medical records from the U.S. Military Health System Data Repository for children enrolled in Tricare health insurance from 2001 to 2013. They identified 8,760 cases of children with autism, and then randomly selected 26,280 control cases based on sex, age and date of Tricare enrollment. For every case, there were three controls.
“We found that those with congenital heart disease were about a third more likely to develop autism than those without congenital heart disease,” said Dr. Oster.
The results advance a current body of research around the relationship between congenital heart disease and neurological disorders like autism, which affects a child’s social skills, communication and behavior as the brain develops and works differently. But a connection between congenital heart disease and autism, specifically, had yet to show significant results of this magnitude.
“Prior research shows children with congenital heart disease have poorer neurodevelopmental outcomes, such as delayed development, poor performance in school, learning disabilities and now, autism,” said Dr. Oster.
Surprisingly, Dr. Oster and his team also observed that children with atrial septal defects and ventricular septal defects—mild heart defects—had a higher risk for autism than those with more severe heart defects.
“It’s the kids who don’t have severe heart disease we need to be more aware of in screening, now that we know the risk to them,” said Dr. Oster.
The cause behind the results, however, is still unknown.
“A leading theory says because the brain and heart are developing around the same time, if something affects one, it might affect both,” said Dr. Oster. “Our results support this theory.”
The team hopes the results will help pediatricians make referrals more quickly when neurological issues like autism-related symptoms arise in congenital heart disease patients. At Children’s, kids with severe congenital heart disease are often referred to the Cardiac Neurodevelopmental Program for early identification and supportive resources.
This research was supported by the Congressional Directed Medical Research Programs Autism Research Award.