Background It has been suggested that parents of children with autism spectrum disorder (ASD) curtail their reproduction, a phenomenon known as reproductive stoppage. To investigate the presence of reproductive stoppage, we followed the reproduction in mothers of children with or without an ASD diagnosis using Swedish population-based registries. Methods We followed all families with first child born in 1987 or later. In total 2,521,103 children, nested within 1,270,017 mothers, were included. Exposure was presence of ASD diagnosis in earlier born siblings, and outcome was considered as (1) inter-pregnancy interval and (2) number of subsequent children. Results Analyses of inter-pregnancy intervals showed that the association differed across birth orders, with a lower rate of second children when first child had ASD diagnosis, but an increased rate of third and higher birth orders in families where a previous child had an ASD diagnosis. When all birth orders were simultaneously considered, families with a child with an ASD diagnosis were less likely to have another child (hazard ratio (HR), 0.79; 95% confidence interval [95% CI], 0.78-0.80). However, when adjusted for birth order, the association was close to null (HR, 0.97; 95% CI, 0.96-0.99), and after additional adjustments (maternal age, birth period, sex, paternal age, and maternal education), the association disappeared (HR, 1.00; 95% CI, 0.99-1.02). In analyses of subsequent children, after adjustment for covariates, families with an ASD diagnosis had 4% more subsequent children (rate ratio, 1.04; 95% CI, 1.03-1.05). Limitations The study was undertaken in a country with largely tax-funded healthcare; results may not generalize to other societies. Following the current dominating umbrella concept of ASD, we did not differentiate between the ASD sub-diagnoses; it is possible that reproductive patterns can be dependent on ASD subtypes and the severity and composition of ASD phenotypes and comorbidities. Conclusions This study does not support a universal reproductive stoppage effect in ASD families, when birth order and other factors are considered. Therefore, proper attention to birth order and other factors may alleviate potential bias in familial aggregation studies of ASD.

中文翻译：

---

250万人口中自闭症谱系障碍的生殖停止。

背景技术已经提出，患有自闭症谱系障碍（ASD）的儿童的父母会减少其生殖，这种现象被称为生殖停止。为了调查生殖停止的存在，我们使用瑞典基于人口的注册表跟踪了有或没有ASD诊断的儿童的母亲的生殖。方法我们追踪所有家庭中有1987年或以后出生的第一个孩子。总共包括2,521,103个孩子，其中1,270,017个母亲被嵌套。暴露是在较早出生的兄弟姐妹中存在ASD诊断，结果被认为是（1）妊娠间隔和（2）随后的孩子数。结果对妊娠间隔的分析表明，这种关联因出生顺序而异，当第一个孩子被诊断出患有ASD时，第二个孩子的发生率较低，但是在以前的孩子被诊断出患有自闭症的家庭中，第三胎和更高的出生率有所增加。当同时考虑所有出生顺序时，有ASD诊断的孩子的家庭生育另一个孩子的可能性较小（危险比（HR）为0.79； 95％的置信区间[95％CI]为0.78-0.80）。但是，如果按出生顺序进行调整，则该关联性接近于零（HR，0.97； 95％CI，0.96-0.99），并且在进行了其他调整（母亲年龄，出生时期，性别，父亲年龄和母亲教育程度）之后，关联消失（HR，1.00; 95％CI，0.99-1.02）。在对后续儿童的分析中，在对协变量进行校正后，诊断为ASD的家庭的后续儿童多4％（比率，1.04； 95％CI，1.03-1.05）。局限性该研究是在一个拥有大量税收支持的医疗保健的国家进行的。结果可能不会推广到其他社会。遵循当前主要的ASD总体概念，我们没有区分ASD子诊断。生殖方式可能取决于ASD亚型以及ASD表型和合并症的严重程度和组成。结论当考虑出生顺序和其他因素时，本研究不支持ASD家庭的普遍生殖停止作用。因此，在ASD的家族聚集研究中，适当注意出生顺序和其他因素可以减轻潜在的偏见。生殖方式可能取决于ASD亚型以及ASD表型和合并症的严重程度和组成。结论当考虑出生顺序和其他因素时，本研究不支持ASD家庭的普遍生殖停止作用。因此，在ASD的家族聚集研究中，适当注意出生顺序和其他因素可以减轻潜在的偏见。生殖方式可能取决于ASD亚型以及ASD表型和合并症的严重程度和组成。结论当考虑出生顺序和其他因素时，本研究不支持ASD家庭的普遍生殖停止作用。因此，在ASD的家族聚集研究中，适当注意出生顺序和其他因素可以减轻潜在的偏见。