Neonatal circumcision was not associated with autism in a US cohort

Design

Prospective multisite cohort (ECHO)

Population

2,771 singleton boys from 14 US sites

Primary outcome

Autism diagnosis and autism trait scores

Effect

Adjusted OR 0.83 (95% CI 0.59 to 1.17)

Concern about a possible link between neonatal circumcision and autism has circulated publicly. This analysis of the US ECHO cohort included 2,771 boys from 14 sites, 66% circumcised before hospital discharge; 7% received an autism diagnosis.

After adjustment for confounders, circumcision was not associated with autism diagnosis (OR 0.83, 95% CI 0.59 to 1.17). Results were similar on validated measures of autism traits (Social Responsiveness Scale) and autism-related behaviours (Child Behavior Checklist), and across strata of region, preterm birth and neonatal intensive care admission.

For clinicians counselling families, this provides reassurance on one specific concern, without bearing on the wider decision about circumcision.

• Reassure parents who raise autism risk that this large cohort found no association with neonatal circumcision.
• Keep counselling on circumcision focused on its established benefits and risks.
• Use adequate analgesia for neonatal circumcision whatever the setting.
• Do not delay autism assessment in a circumcised boy with developmental concerns; the two are unrelated here.

Why it matters

It answers a question parents are increasingly bringing to appointments.

Don't overread it

Observational, and autism diagnosis was partly by parent report.

The statistics, in plain English

An odds ratio of 0.83 with an interval of 0.59 to 1.17 includes 1, so there was no detectable association. The upper limit of 1.17 makes a substantial increase in risk unlikely.

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