Can Birth Injuries Cause Autism Spectrum Disorder?

If your child experienced complications during delivery and has since been diagnosed with autism, you may be wondering whether the two are connected. It’s a question many families ask, and the answer is more nuanced than a simple yes or no.

Current medical research shows that while birth injuries don’t directly cause autism spectrum disorder (ASD), certain complications during labor and delivery are associated with a modestly increased risk of autism diagnosis, particularly when combined with genetic or other environmental factors.

This article breaks down what we know from recent studies, which specific birth complications show the strongest associations with autism, and what this information means for families navigating both diagnoses.

What the Research Actually Shows About Birth Complications and Autism Risk

The Centers for Disease Control and Prevention (CDC) confirms that autism doesn’t have a single identifiable cause. Instead, both genetic factors and environmental influences, including certain events during pregnancy or birth, may increase the likelihood of an autism diagnosis.

A large international study published in 2025 examined thousands of births and found that babies with low Apgar scores (indicating distress immediately after birth) faced a higher risk of autism diagnosis later in childhood, particularly more severe forms. Low Apgar scores can result from oxygen deprivation, infection, or delayed delivery, situations that sometimes overlap with birth injuries.

Perhaps most significantly, a comprehensive analysis published by the National Institutes of Health reviewed 40 separate studies on this topic. Researchers identified several perinatal factors associated with increased autism risk, including birth injury or trauma (with a relative risk of 4.9), fetal distress (relative risk of 1.5), umbilical cord complications, low birth weight, and low five-minute Apgar scores.

However, these numbers require important context: many children who experience these complications never develop autism, and most children with autism had no documented birth complications.

Why Birth Injuries Might Be Linked to Autism Without Actually Causing It

Understanding the relationship between birth complications and autism requires looking at two competing theories that researchers are actively investigating.

The Shared Risk Hypothesis

Some scientists believe that the connection between difficult births and autism may not be causal at all. Instead, both the birth complications and the later autism diagnosis might stem from the same underlying source, such as genetic variations or developmental abnormalities that began earlier in pregnancy. In this scenario, the difficult birth is a symptom rather than a cause.

The Indirect Pathway Theory

Other researchers propose that severe perinatal events like oxygen deprivation, brain inflammation, or trauma can alter early brain development in ways that increase autism risk, particularly when combined with genetic predispositions. According to this theory, birth complications might act as one of several “hits” to a developing system that was already vulnerable.

Neither theory has been definitively proven, and the truth likely involves elements of both, varying from case to case.

Which Birth Complications Show the Strongest Association with Autism

Not all birth complications carry the same level of association with later autism diagnosis. Research has identified specific events that appear more frequently in the medical histories of children later diagnosed with ASD:

• Low Apgar score (less than 7 at the five-minute mark)
• Umbilical cord complications such as prolapse or cord wrapped around the neck
• Birth asphyxia or hypoxic ischemic encephalopathy (HIE)
• Fetal distress during labor
• Maternal hemorrhage during delivery
• Very low birth weight
• Congenital malformations present at birth
• Neonatal anemia or severe jaundice (hyperbilirubinemia)
• Perinatal stroke or bleeding inside the skull

If your child experienced any of these complications, it’s important to remember that the increased risk is still relatively modest, and most children with these birth histories do not develop autism.

What Birth Complications Are Not Linked to Autism

Just as important as knowing which complications show associations with autism is understanding what doesn’t appear to increase risk based on current evidence.

Routine delivery interventions, standard perinatal procedures, and uncomplicated cesarean sections have not been linked to increased autism risk in quality studies. Additionally, recent high-quality research has not found a significant connection between preterm birth alone and autism risk, despite some earlier studies suggesting otherwise.

Importantly, current science does not support the idea that a single birth complication or isolated trauma directly causes autism as a sole factor. The development of ASD appears to require a convergence of multiple influences.

Understanding Apgar Scores and What They Mean for Development

The Apgar score is one of the most commonly referenced measures when discussing birth outcomes. Named after Dr. Virginia Apgar who developed it in 1952, this quick assessment evaluates five factors at one minute and again at five minutes after birth: heart rate, breathing effort, muscle tone, reflexes, and skin color.

Each factor receives a score of 0, 1, or 2, for a maximum total of 10. A score of 7 or above at five minutes is considered normal, while scores below 7 indicate that the baby needed or may still need medical assistance.

The five-minute Apgar score is particularly significant in research on developmental outcomes because it reflects how well a baby is transitioning to life outside the womb after initial interventions. Persistently low scores may indicate that the baby experienced oxygen deprivation or other stresses that could affect the brain.

In the context of autism research, babies with five-minute Apgar scores below 7 have shown higher rates of later ASD diagnosis in multiple studies. However, many babies with low Apgar scores develop typically, and many children with autism had normal Apgar scores at birth.

How Oxygen Deprivation During Birth Affects Brain Development

Hypoxic ischemic encephalopathy (HIE), or birth asphyxia, occurs when a baby’s brain doesn’t receive enough oxygen and blood flow during labor, delivery, or immediately after birth. This can happen due to placental problems, umbilical cord complications, prolonged labor, or other obstetric emergencies.

When brain tissue is deprived of oxygen, cells can be damaged or die. The severity and location of this damage determine the long-term outcomes. Mild cases may resolve without lasting effects, while moderate to severe HIE can result in cerebral palsy, developmental delays, seizure disorders, and cognitive impairments.

The relationship between HIE and autism is complex. Some children with documented birth asphyxia are later diagnosed with ASD, but whether the oxygen deprivation directly contributed to autism development, or whether both conditions share an underlying cause, remains unclear. Research suggests that when HIE and autism co-occur, other factors are typically involved as well, including genetic vulnerabilities.

Medical teams now use therapeutic hypothermia (controlled cooling) immediately after birth for babies with moderate to severe HIE, which has been shown to reduce the extent of brain injury and improve outcomes. This intervention represents one of the few opportunities to potentially modify the trajectory after a complicated birth.

The Role of Umbilical Cord Complications in Birth Outcomes

The umbilical cord is the lifeline connecting baby to placenta, delivering oxygen-rich blood and nutrients while removing waste. Several types of cord complications can occur during pregnancy and delivery:

Nuchal Cord

This term refers to the umbilical cord wrapping around the baby’s neck, which happens in roughly 25-30% of all births. Most nuchal cords are loose and cause no problems, but tight wrapping, especially with multiple loops, can restrict blood flow during contractions.

Cord Prolapse

In this emergency situation, the umbilical cord slips through the cervix ahead of the baby, where it can become compressed between the baby and the birth canal. This occurs in fewer than 1% of births but requires immediate delivery to prevent oxygen deprivation.

True Knot

Sometimes the cord literally ties itself in a knot as the baby moves in the womb. If the knot tightens during labor, it can reduce blood flow.

Cord Compression

Even without prolapse or knots, the cord can become compressed during labor, particularly in cases of low amniotic fluid or certain fetal positions.

Studies have identified umbilical cord complications as one of the perinatal factors associated with increased autism risk. The likely mechanism involves temporary or prolonged reduction in oxygen delivery to the developing brain, though again, most babies who experience cord complications develop typically.

When Birth Injuries and Autism Occur Together

If your child has both a documented birth injury and an autism diagnosis, you’re dealing with two distinct but potentially related conditions that require coordinated care.

The majority of children with autism do not have a known birth injury, and most children who experience birth complications do not develop autism. When both occur in the same child, several scenarios are possible:

The birth injury and autism may be completely unrelated, with separate causes that happened to affect the same child. Given that autism affects approximately 1 in 36 children according to recent CDC data, some children with birth injuries would be expected to have autism by chance alone.

The birth complication may have contributed to autism development as one of several risk factors in a child who had genetic or other predispositions. In this scenario, neither the genetics nor the birth event alone would have been sufficient, but together they crossed a threshold.

An underlying developmental abnormality may have caused both the difficult birth and the autism, meaning the birth complications were an early sign of existing differences rather than a cause of later problems.

Distinguishing between these possibilities in individual cases is often impossible, even with extensive testing. What matters more for families is ensuring the child receives appropriate evaluations, early intervention services, and ongoing support for both conditions.

What Medical Evaluation Looks Like When Both Conditions Are Present

When a child has a history of birth complications and shows signs of autism, medical providers typically recommend comprehensive evaluation to understand the full picture of the child’s development and needs.

This evaluation usually involves developmental pediatricians or child neurologists who can assess whether the birth injury caused identifiable brain damage (visible on imaging or causing specific motor or cognitive impairments) and separately evaluate autism symptoms and severity.

Neuroimaging such as MRI may be ordered if not already completed, particularly if the birth injury was severe. These scans can show whether there is structural brain damage from the perinatal event, though autism itself doesn’t have a characteristic appearance on standard brain imaging.

Developmental assessments track skills across multiple domains including motor, language, social, cognitive, and adaptive functioning. This helps distinguish which challenges may relate to documented brain injury from birth and which are characteristic of autism.

Genetic testing is increasingly recommended for children with autism, as specific genetic variations are found in 10-30% of cases. Finding a genetic cause doesn’t necessarily mean the birth injury was unrelated; some genetic conditions may increase both autism risk and the likelihood of birth complications.

The goal isn’t necessarily to assign a single cause, but rather to understand the child’s unique profile so therapies and interventions can be appropriately targeted.

Early Intervention Regardless of Cause

One of the most important things to understand about the birth injury and autism connection is that early intervention helps children make progress regardless of what caused their developmental differences.

Children who receive early intensive behavioral intervention for autism, typically starting before age 3, show better outcomes in language, social skills, and adaptive functioning. These benefits apply whether or not there was a birth complication in their history.

Similarly, children with documented brain injury from birth events benefit from early physical therapy, occupational therapy, and speech therapy to maximize their developmental potential during the critical early years when the brain has the most plasticity.

If your child has both a birth injury history and autism characteristics, they may need a combination of approaches including applied behavior analysis (ABA) or other autism-specific interventions, developmental therapies addressing motor or cognitive delays from the injury, and family support services to help navigate the complexity of both diagnoses.

The earlier these services begin, the better the outcomes tend to be. Most states have early intervention programs that provide evaluation and services for children under age 3 at no cost to families, regardless of income.

The Genetic Component of Autism Cannot Be Overlooked

While this article focuses on birth complications, understanding autism requires acknowledging that genetic factors are the strongest identified contributors to ASD risk.

Research consistently shows that autism runs in families. If one child has autism, siblings have a roughly 10-20% chance of also being diagnosed, much higher than the general population risk. Identical twins show concordance rates of 60-90%, meaning if one twin has autism, the other very often does as well.

Scientists have identified hundreds of genes that contribute to autism risk, though no single gene accounts for more than a small fraction of cases. Most autism appears to involve the combined effects of many common genetic variants, each contributing a small amount to overall risk.

This genetic component is crucial when interpreting the connection between birth complications and autism. A child who inherits multiple autism-related genetic variants may be more vulnerable to environmental factors, including perinatal stress. The same birth complication might increase autism risk in a genetically susceptible child while having no effect in a child without that genetic background.

This doesn’t mean parents should blame themselves if their family has genetic risk factors any more than they should blame themselves for birth complications. Both are biological events beyond anyone’s control.

What This Information Means for Families

If you’re reading this because your child experienced birth complications and you’re worried about autism risk, the most helpful perspective is one of informed awareness without excessive anxiety.

The increased risk associated with birth complications is real but modest. Even factors with the highest relative risk, like documented birth injury, still mean that most affected children will not develop autism.

Early monitoring makes sense. If your child had significant birth complications, discussing developmental surveillance with your pediatrician ensures that any concerns are identified early when intervention is most effective. This doesn’t mean assuming problems will develop, but rather watching thoughtfully.

Trust your instincts about your child’s development. Parents are usually the first to notice when something doesn’t seem quite right with communication, social interaction, or behavior. If you have concerns, seeking evaluation is always appropriate, regardless of birth history.

If your child does receive an autism diagnosis after a complicated birth, remember that understanding causation matters less than accessing effective support. Whether the birth event contributed, was coincidental, or shared an underlying cause with the autism, your child’s needs remain the same.

Current Medical Opinion on Causation Versus Association

The medical consensus has shifted over the past two decades as research methods have improved and larger, more rigorous studies have been completed.

Earlier observational studies often reported associations between various perinatal complications and autism, but couldn’t adequately control for confounding factors or determine direction of causation. This led to conflicting findings and uncertainty about which complications truly mattered.

More recent research using better methodology, larger sample sizes, and statistical techniques that can account for genetic and familial factors has provided clarity. The current scientific position is that birth injuries and complications are associated with modestly increased autism risk but are not direct causes in the way that, for example, rubella infection during pregnancy directly causes congenital rubella syndrome.

The distinction between association and causation is crucial. Association means two things occur together more often than would be expected by chance. Causation means one thing directly produces the other. Proving causation requires meeting several criteria: the proposed cause must precede the effect, there must be a plausible biological mechanism, the association must be strong and consistent across studies, and ideally, preventing the cause should prevent the effect.

Birth complications meet some but not all of these criteria for autism. They do precede diagnosis, there are plausible mechanisms involving brain development, and associations are consistent across studies. However, the associations are not strong enough to be considered causative on their own, and most autism cases occur without identifiable birth complications.

Legal Considerations When Birth Injury and Autism Co-Occur

If your child has both a birth injury and autism, you may wonder about the legal implications, particularly if you believe the birth injury resulted from medical negligence.

Medical malpractice claims related to birth injuries typically focus on whether care providers deviated from accepted standards of care in a way that directly caused harm. Conditions that are clearly and immediately traceable to specific events during delivery, such as brachial plexus injury (Erb’s palsy) from shoulder dystocia or cerebral palsy from severe documented HIE, are more straightforward to evaluate legally.

Autism presents a more complicated picture in the legal context because of the multifactorial causation and the typical delay between birth and diagnosis. Even when a child has both a documented birth injury and autism, establishing that the birth event caused or substantially contributed to the autism diagnosis is medically and legally challenging given current scientific understanding.

These cases typically require extensive expert medical testimony, detailed review of medical records, developmental history, and often genetic testing to characterize the relative contributions of various factors.

If you’re considering legal consultation, documentation is essential. Preserve all medical records from pregnancy, labor, delivery, and the newborn period, as well as all subsequent developmental evaluations and diagnoses. Statutes of limitations vary by state, so if you have concerns about the care you received, consulting with an attorney experienced in birth injury cases sooner rather than later is advisable.

The goal of legal consultation isn’t necessarily litigation; sometimes families simply want answers about what happened and whether different decisions might have changed outcomes.

Questions to Discuss with Your Child’s Medical Team

If your child experienced birth complications and you’re concerned about development, consider asking these questions at upcoming appointments:

Given the specific complications during birth, what developmental monitoring does my child need? Should we watch for anything particular?

At what ages should my child reach specific milestones for communication, social interaction, and behavior? What would be concerning enough to warrant evaluation?

Would a referral to a developmental specialist be appropriate now, or should we continue monitoring with you?

If my child shows signs of developmental differences, what does the evaluation process look like, and how quickly can it be arranged?

Are there early intervention services available now that might benefit my child, even before a specific diagnosis?

If autism is diagnosed, how do we determine whether it’s related to the birth complications, and does that relationship affect treatment recommendations?

What resources are available to help our family navigate both the birth injury effects and developmental concerns?

These conversations help ensure you and your pediatrician are partners in monitoring your child’s development with appropriate vigilance.

Moving Forward with Knowledge and Support

The relationship between birth injuries and autism is neither simple causation nor pure coincidence. It falls somewhere in between, a complex interaction of genetic vulnerability, environmental factors, and sometimes the additional stress of perinatal complications.

For families living with both diagnoses, what matters most is not definitively answering whether one caused the other, but rather accessing comprehensive evaluation, effective early intervention, and ongoing support tailored to your child’s unique needs.

Medical science continues to refine our understanding of what contributes to autism development. Each large study adds clarity, and new research methods allow investigators to untangle causation from association more effectively than was possible even a decade ago.

If your child experienced a difficult birth, appropriate vigilance about development makes sense. If your child has been diagnosed with autism whether or not there was a birth complication, early, intensive intervention offers the best opportunity for progress.

Perhaps most importantly, neither birth complications nor autism reflects anything a parent did wrong. These are biological events that happen despite the best intentions, the best prenatal care, and the best hopes for an uncomplicated delivery and typical development.

Resources exist to support families through both birth injury recovery and autism diagnosis, and connecting with other families facing similar situations can provide both practical advice and emotional support that makes the journey less isolating.

Finding Reliable Information and Support

As you navigate questions about birth complications and autism, be selective about information sources. The internet contains a mix of solid, research-based information and misleading claims about causes and cures.

Trusted sources for information include the CDC’s autism resources, the National Institute of Child Health and Human Development, established autism organizations like Autism Speaks (despite some controversy, their information on autism basics is generally accurate) and the Autism Science Foundation, and peer-reviewed medical journals accessible through PubMed.

For support specific to birth injuries, organizations like the United Cerebral Palsy Foundation, the HIE Help Center, and specialized legal resources provide information about medical conditions, treatment options, and family support even if cerebral palsy isn’t your child’s diagnosis.

Local early intervention programs, usually coordinated through your state’s health or education department, offer evaluation and services for children under three. Your pediatrician can provide a referral, or you can typically self-refer by contacting the program directly.

Parent support groups, both in-person and online, provide community with others who understand the unique challenges of raising a child with complex medical and developmental needs. Many hospitals and therapy centers facilitate these groups, and autism-specific organizations often have local chapters that host family events and support meetings.

The path forward involves gathering knowledge, accessing appropriate services, connecting with support, and focusing on your individual child’s progress rather than comparing to typical development or worrying about what might have been different.