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Non\u2010vertex presentation (malpresentation) complicates delivery and often leads to caesarean section, which has been associated with neurodevelopmental delays, including autism spectrum disorder (ASD). However, malpresentation could be an early sign of an existing developmental problem that is also an upstream factor from caesarean delivery. Little research has been done to investigate the association between malpresentation and ASD.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objectives<\/jats:title><jats:p>We examine the association between malpresentation at delivery and ASD and whether this association differs by gestational age.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We used data from the Study to Explore Early Development (SEED), a multi\u2010site, case\u2013control study of children with ASD compared to population controls. The foetal presentation was determined using medical records, birth records and maternal interviews. We defined malpresentation as a non\u2010vertex presentation at delivery, then further categorised into breech and other malpresentation. We used multivariable logistic regression to estimate the adjusted odds ratio (aOR) for the association between malpresentation and ASD.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We included 4047 SEED participants, 1873 children with ASD and 2174 controls. At delivery, most infants presented vertex (<jats:italic>n<\/jats:italic>\u2009=\u20093760, 92.9%). Malpresentation was associated with higher odds of ASD (aOR 1.31, 95% confidence interval [CI] 1.02, 1.68) after adjustment for maternal age, poverty level, hypertensive disorder and smoking. The association was similar for breech and other types of malpresentation (aOR 1.28, 95% CI 0.97, 1.70 and aOR 1.40, 95% CI 0.87, 2.26, respectively) and did not differ markedly by gestational age.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Malpresentation at delivery was modestly associated with ASD. Early monitoring of the neurodevelopment of children born with malpresentation could identify children with ASD sooner and enhance opportunities to provide support to optimise developmental outcomes.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ppe.13082","type":"journal-article","created":{"date-parts":[[2024,6,21]],"date-time":"2024-06-21T08:00:42Z","timestamp":1718956842000},"page":"397-407","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Malpresentation and autism spectrum disorder in the study to explore early development"],"prefix":"10.1111","volume":"38","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-9029-7650","authenticated-orcid":false,"given":"Yitian","family":"Zhang","sequence":"first","affiliation":[{"name":"Epidemiology and Database Studies Real World Solutions, IQVIA Inc  Durham USA"},{"name":"Department of Epidemiology, Gillings School of Global Public Health University of North Carolina at Chapel Hill  Chapel Hill USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7914-264X","authenticated-orcid":false,"given":"Michelle T.","family":"Delahanty","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Gillings School of Global Public Health University of North Carolina at Chapel Hill  Chapel Hill USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3942-1246","authenticated-orcid":false,"given":"Stephanie M.","family":"Engel","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Gillings School of Global Public Health University of North Carolina at Chapel Hill  Chapel Hill USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen","family":"Marshall","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Gillings School of Global Public Health University of North Carolina at Chapel Hill  Chapel Hill USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"T. Michael","family":"O'Shea","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, School of Medicine University of North Carolina at Chapel Hill  Chapel Hill USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tanya","family":"Garcia","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, Gillings School of Global Public Health University of North Carolina at Chapel Hill  Chapel Hill USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura A.","family":"Schieve","sequence":"additional","affiliation":[{"name":"National Center on Birth Defects and Developmental Disabilities Centers for Disease Control and Prevention  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5264-4340","authenticated-orcid":false,"given":"Chyrise","family":"Bradley","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Gillings School of Global Public Health University of North Carolina at Chapel Hill  Chapel Hill USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9658-3743","authenticated-orcid":false,"given":"Julie L.","family":"Daniels","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Gillings School of Global Public Health University of North Carolina at Chapel Hill  Chapel Hill USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,6,21]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.21037\/tp.2019.09.09"},{"key":"e_1_2_11_3_1","volume-title":"Autism Prevalence Higher, According to Data from 11 ADDM Communities","author":"CDC","year":"2023"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jval.2017.01.007"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1001\/archgenpsychiatry.2011.76"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41380-018-0330-z"},{"key":"e_1_2_11_7_1","first-page":"429","article-title":"Caesarean section and risk of autism across gestational age: a multi\u2010national cohort study of 5 million births","volume":"46","author":"Yip BHK","year":"2016","journal-title":"Int J Epidemiol"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000006696"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2005.09.009"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1067\/mob.2002.127902"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/aogs.12726"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jogc.2020.04.020"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1002\/ana.410020505"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0188074"},{"key":"e_1_2_11_15_1","first-page":"967","article-title":"Maternal diabetes and hypertensive disorders in association with autism spectrum disorder. 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