Adolescents with autism less likely to visit ob/gyn, receive contraceptives

Autism spectrum disorder may impact the frequency of which adolescents visit their obstetrician-gynecologist (ob/gyn) and therefore affect their use of hormonal contraception, according to a new study.¹

A cohort analysis of trial participants from Kaiser Permanente Northern California showed adolescents with autism and other developmental disabilities were more likely to report menstruation-related conditions and were additionally less likely to access an ob/gyn and hormonal contraception relative to their peers. The findings warrant further qualitative research into contextualizing factors including age of menarche and sexual activity in such youth patients with autism, as well as the effect of sexually transmitted infection (STI) incidence.

Investigators led by Jennifer L. Ames, PhD, of the division of research at Kaiser Permanente, sought to characterize the use of reproductive health services among teenagers with autism relative their peers without developmental disabilities. Historically, adolescents with developmental disabilities have had less access to reproductive and sexual health resources including guidance on contraception and cervical cancer screening.

“However, little is known about how this population accesses contraception and obstetrics-gynecology care during adolescence,” investigators wrote. “Previous studies suggest that reproductive health topics are routinely neglected when youth with DD are transitioning to adulthood. Suboptimal sexual and reproductive healthcare may place youth with autism and other DD at higher risk of reproductive health problems.”

The impact of autism spectrum disorder on reproductive health has been a well-explored subject in recent years, with investigations previously establishing a link between the developmental disorder and infertility risk,² as well as risk of preterm birth.³

Ames and colleagues conducted their cohort analysis using data from adolescents treated in the Kaiser Permanente health care system between aged 14 – 18 years old.¹ They obtained patient information on menstrual conditions, ob/gyn care, and hormonal contraception prescription via electronic record. They compared patient utility stratified by autism status, other developmental disorder, or neither.

The analysis included 700 adolescents with autism, 836 with other developmental disabilities, and 2187 typically developing adolescents who received care in 2000 – 2017. Among the autism cohort, patients were primarily White (54.6%) and privately insured (87.6%).

Investigators found that adolescents with autism were 18% more likely to report menstrual disorders than typically developing adolescents (adjusted relative risk [aRR], 1.20; 95% CI, 1.08 – 1.34); they were additionally 75% more likely to report polycystic ovarian syndrome (PCOS) (aRR, 1.75; 95% CI, 1.42 – 2.15) and more than 3-fold likely to report premenstrual syndrome (aRR, 3.18; 95% CI, 1.97 – 5.14).

Only 199 (28.4%) of adolescents with autism reported a visit to an ob/gyn for any reason between ages 14 – 18, compared to 854 (39.1%) typically developing adolescents. Adolescents with autism were nearly 10% less likely to receive any hormonal contraception than typically developing adolescent (34.3% vs 43.8%). A similar difference was observed in the rate of adolescents taking any oral contraceptive pill (28.3% vs 38.0%).

Analysis showed adolescents with autism were 31% less likely to visit an ob/gyn between ages 14 – 18 years old (aRR, 0.69; 95% CI, 0.61 – 0.78). They were additionally 58% less likely to be screened for an STI (aRR, 0.42; 95% CI, 0.36 – 0.49).

“However, adolescents with autism and developmental disorders who did go to an obstetrician-gynecologist or who used hormonal contraception during the ages of 14 to 18 years tended to first use these services at a younger age than their typically developing counterparts,” investigators noted. “Most adolescents in the sample accessed hormonal contraception through their primary care provider.”

Though the findings are limited by the lack of data regarding menarche age and sexual activity among the cohorts, as well as the utility of reproductive health services from other settings including Planned Parenthood, the team concluded their findings warrant an exploration further into the sexual and reproductive health tendencies of adolescents with developmental disorders—and the implications of those tendencies.

“More nuanced exploration of the differences in care by types of disability, including co-occurring intellectual disability, support needs, and communication preferences, is also needed,” investigators concluded. “Our study suggests that efforts to improve reproductive healthcare during the transition to adulthood will benefit from examining reproductive health services delivered in both pediatric and obstetrics-gynecology settings.”

References

1. ^{Ames JL, Anderson MC, Cronbach E, et al. Reproductive healthcare in adolescents with autism and other developmental disabilities. Am J Obstet Gynecol. 2024;230(5):546.e1-546.e14. doi:10.1016/j.ajog.2024.01.005}
2. ^{Krewson C. Link between infertility and autism spectrum disorder risk. Contemporary OB/GYN. Published December 6, 2023. https://www.contemporaryobgyn.net/view/link-between-infertility-and-autism-spectrum-disorder-risk}
3. ^{Kunzmann K. Autistic traits among women linked to increased preterm births. Contemporary OB/GYN. Published January 24, 2024. https://www.contemporaryobgyn.net/view/autistic-traits-women-linked-increased-preterm-births}