Research from Pediatric Cardiologist Suggests Kids with Congenital Heart Disease are More Likely to Develop Autism

ATLANTA – Kids with congenital heart disease are 32% more likely to develop autism spectrum disorder, according to research led by Matthew Oster, MD, MPH, a Pediatric Cardiologist in the Children's Healthcare of Atlanta Heart Center. The findings, published last month in Pediatrics, may lead to earlier detection of autism in congenital heart disease patients.

“If a kid has heart defects, parents and providers should be aware they’re at a slightly higher risk for neurodevelopmental problems like autism,” said Dr. Oster, Director of Children’s Cardiac Outcomes Research Program and Associate Professor at Emory University School of Medicine. “If they do have neurodevelopmental problems, then we know to get them the services they need as quickly as possible.”

Congenital heart disease, which is when the heart fails to develop normally before birth causing abnormalities like a hole in the heart, is the most common birth defect, affecting nearly 1 in 100 kids born in the U.S. At the same time, 1 in 59 kids in the U.S. will meet the diagnostic criteria for autism by age 8.

Dr. Oster and his colleagues at Emory University and Uniform Services University of the Health Sciences conducted a retrospective case control study using medical records from the U.S. Military Health System Data Repository for children enrolled in Tricare health insurance from 2001 to 2013. They identified 8,760 cases of children with autism, and then randomly selected 26,280 control cases based on sex, age and date of Tricare enrollment. For every case, there were three controls.

“We found that those with congenital heart disease were about a third more likely to develop autism than those without congenital heart disease,” said Dr. Oster.

The results advance a current body of research around the relationship between congenital heart disease and neurological disorders like autism, which affects a child’s social skills, communication and behavior as the brain develops and works differently. But a connection between congenital heart disease and autism, specifically, had yet to show significant results of this magnitude.

“Prior research shows children with congenital heart disease have poorer neurodevelopmental outcomes, such as delayed development, poor performance in school, learning disabilities and now, autism,” said Dr. Oster.

Surprisingly, Dr. Oster and his team also observed that children with atrial septal defects and ventricular septal defects—mild heart defects—had a higher risk for autism than those with more severe heart defects.

“It’s the kids who don’t have severe heart disease we need to be more aware of in screening, now that we know the risk to them,” said Dr. Oster.

The cause behind the results, however, is still unknown.

“A leading theory says because the brain and heart are developing around the same time, if something affects one, it might affect both,” said Dr. Oster. “Our results support this theory.”

The team hopes the results will help pediatricians make referrals more quickly when neurological issues like autism-related symptoms arise in congenital heart disease patients. At Children’s, kids with severe congenital heart disease are often referred to the Cardiac Neurodevelopmental Program for early identification and supportive resources.

This research was supported by the Congressional Directed Medical Research Programs Autism Research Award.

For more information:

Julie Kuchta

Children's Healthcare of Atlanta


About Children’s Healthcare of Atlanta

As the only freestanding pediatric healthcare system in Georgia, Children’s Healthcare of Atlanta is the trusted leader in caring for kids. The not-for-profit organization’s mission is to make kids better today and healthier tomorrow through more than 60 pediatric specialties and programs, top healthcare professionals, and leading research and technology. Children’s is one of the largest pediatric clinical care providers in the country, managing more than one million patient visits annually at three hospitals, Marcus Autism Center, the Center for Advanced Pediatrics, urgent care centers and neighborhood locations. Consistently ranked among the top children’s hospitals by U.S. News & World Report, Children’s Healthcare of Atlanta has impacted the lives of kids in Georgia, across the United States and around the world for more than 100 years thanks to generous support from the community.

About Emory University School of Medicine

About Emory University School of Medicine
Emory University School of Medicine is a leading institution with the highest standards in education, biomedical research and patient care, with a commitment to recruiting and developing a diverse group of students and innovative leaders. Emory School of Medicine has more than 3,400 full- and part-time faculty, 592 medical students, 497 allied health students in five programs, 1,388 residents and fellows in 115 accredited programs, and 92 MD/PhD students. Medical school faculty received $588.4 million in external research funding in fiscal year 2022. The school is best known for its research and treatment in infectious disease, brain health, heart disease, cancer, transplantation, orthopaedics, pediatrics, renal disease, ophthalmology and geriatrics.

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