Neonatal Medical Male Circumcision and Child Autism Diagnosis
Monica McGrath, Xiuhong Li, Lisa P. Jacobson, Bennett Leventhal, Judy L. Aschner, Brennan Baker, Karla Cardoso Garcia, Aisha S. Dickerson, Amy J. Elliott, Jody Ganiban, Amanda Goodrich, Daniel B. Horton, Melinda Jarnecke, Sarah Keim, Brian K. Lee, Courtney D. Lynch, Mark Klebanoff, Abdul-Manaf Mutaru, Ruby H. N. Nguyen, Rebecca J. Schmidt, Hyeong-Moo Shin, Lauren C. Shuffrey, Jonathan L. Slaughter, Annemarie Stroustrup, Zhaozhong Zhu, Aaron A. R. Tobian, M. Kate Grabowski, , P Brian Smith, L Kristin Newby, Linda Adair, Lisa P. Jacobson, Diane Catellier, Monica McGrath, Christian Douglas, Priya Duggal, Emily Knapp, Amii Kress, Courtney K. Blackwell, Maxwell A. Mansolf, Jin-Shei Lai, Emily Ho, David Cella, Richard Gershon, Michelle L. Macy, Suman R. Das, Jane E. Freedman, Simon A. Mallal, John A. McLean, Ravi V. Shah, Meghan H. Shilts, Akram N. Alshawabkeh, Jose F. Cordero, John Meeker, Leonardo Trasande, Carlos A. Camargo, Kohei Hasegawa, Zhaozhong Zhu, Ashley F. Sullivan, Dana Dabelea, Wei Perng, Traci A. Bekelman, Greta Wilkening, Sheryl Magzamen, Brianna F. Moore, Anne P. Starling, Deborah J. Rinehart, Daphne Koinis Mitchell, Viren D'Sa, Sean C.L. Deoni, Hans-Georg Mueller, Cristiane S. Duarte, Catherine Monk, Glorisa Canino, Jonathan Posner, Tenneill Murray, Claudia Lugo-Candelas, Anne L. Dunlop, Patricia A. Brennan, Christine Hockett, Amy Elliott, Assiamira Ferrara, Lisa A. Croen, Monique M. Hedderson, John Ainsworth, Leonard B. Bacharier, Casper G. Bendixsen, James E. Gern, Diane R. Gold, Tina V. Hartert, Daniel J. Jackson, Christine C. Johnson, Christine L.M. Joseph, Meyer Kattan, Gurjit K. Khurana Hershey, Robert F. Lemanske, Jr., Susan V. Lynch, Rachel L. Miller, George T. O’Connor, Carole Ober, Dennis Ownby, Katherine Rivera-Spoljaric, Patrick H. Ryan, Christine M. Seroogy, Anne Marie Singh, Robert A. Wood, Edward M. Zoratti, Rima Habre, Shohreh Farzan, Frank D. Gilliland, Irva Hertz-Picciotto, Deborah H. Bennett, Julie B. Schweitzer, Rebecca J. Schmidt, Janine M. LaSalle, Alison E. Hipwell, Catherine J. Karr, Nicole R. Bush, Kaja Z. LeWinn, Sheela Sathyanarayana, Qi Zhao, Frances Tylavsky, Kecia N. Carroll, Christine T. Loftus, Leslie D. Leve, Jody M. Ganiban, Jenae M. Neiderhiser, Scott T. Weiss, Augusto A. Litonjua, Cindy T. McEvoy, Eliot R. Spindel, Robert S. Tepper, Craig J. Newschaffer, Kristen Lyall, Heather E. Volk, Rebecca Landa, Sally Ozonoff, Joseph Piven, Heather Hazlett, Juhi Pandey, Robert Schultz, Steven Dager, Kelly Botteron, Daniel Messinger, Wendy Stone, Jennifer Ames, Thomas G. O'Connor, Richard K. Miller, Emily Oken, Michele R. Hacker, Tamarra James-Todd, T. Michael O'Shea, Rebecca C. Fry, Jean A. Frazier, Rachana Singh, Caitlin Rollins, Angela Montgomery, Ruben Vaidya, Robert M. Joseph, Lisa K. Washburn, Semsa Gogcu, Kelly Bear, Julie V. Rollins, Stephen R. Hooper, Genevieve Taylor, Wesley Jackson, Amanda Thompson, Julie Daniels, Michelle Hernandez, Kun Lu, Michael Msall, Madeleine Lenski, Rawad Obeid, Steven L. Pastyrnak, Elizabeth Jensen, Christina Sakai, Hudson Santos, Jean M. Kerver, Nigel Paneth, Charles J. Barone, Michael R. Elliott, Douglas M. Ruden, Chris Fussman, Julie B. Herbstman, Amy Margolis, Susan L. Schantz, Sarah Dee Geiger, Andrea Aguiar, Karen Tabb, Rita Strakovsky, Tracey Woodruff, Rachel Morello-Frosch, Amy Padula, Joseph B. Stanford, Christina A. Porucznik, Angelo P. Giardino, Rosalind J. Wright, Robert O. Wright, Brent Collett, Nicole Baumann-Blackmore, Ronald Gangnon, Chris G. McKennan, Jo Wilson, Matt Altman, Judy L. Aschner, Annemarie Stroustrup, Stephanie L. Merhar, Paul E. Moore, Gloria S. Pryhuber, Mark Hudak, Ann Marie Reynolds Lyndaker, Andrea L. Lampland, Burton Rochelson, Sophia Jan, Matthew J. Blitz, Michelle W. Katzow, Zenobia Brown, Codruta Chiuzan, Timothy Rafael, Dawnette Lewis, Natalie Meirowitz, Brenda Poindexter, Tebeb Gebretsadik, Sarah Osmundson, Jennifer K. Straughen, Amy Eapen, Andrea Cassidy-Bushrow, Ganesa Wegienka, Alex Sitarik, Kim Woodcroft, Audrey Urquhart, Albert Levin, Tisa Johnson-Hooper, Brent Davidson, Tengfei Ma, Emily S. Barrett, Martin J. Blaser, Maria Gloria Dominguez-Bello, Daniel B. Horton, Manuel Jimenez, Todd Rosen, Kristy Palomares, Lyndsay A. Avalos, Yeyi Zhu, Kelly J . Hunt, Roger B. Newman, Michael S. Bloom, Mallory H. Alkis, James R. Roberts, Sunni L. Mumford, Heather H. Burris, Sara B. DeMauro, Lynn M. Yee, Aaron Hamvas, Antonia F. Olidipo, Andrew S. Haddad, Lisa R. Eiland, Nicole T. Spillane, Kirin N. Suri, Stephanie A. Fisher, Jeffrey A. Goldstein, Leena B. Mithal, Raye-Ann O. DeRegnier, Nathalie L. Maitre, Ruby H.N. Nguyen, Meghan M. JaKa, Abbey C. Sidebottom, Michael J. Paidas, JoNell E. Potter, Natale Ruby, Lunthita Duthely, Arumugam Jayakumar, Karen Young, Isabel Maldonado, Meghan Miller, Jonathan L. Slaughter, Sarah A. Keim, Courtney D. Lynch, Kartik K. Venkatesh, Kristina W. Whitworth, Elaine Symanski, Thomas F. Northrup, Hector Mendez-Figueroa, Ricardo A. Mosquera, Margaret R. Karagas, Juliette C. Madan, Debra M. MacKenzie, Johnnye L. Lewis, Brandon J. Rennie, Bennett L. Leventhal, Young Shin Kim, Somer Bishop, Sara S. Nozadi, Li Luo, Barry M. Lester, Carmen J. Marsit, Todd Everson, Cynthia M. Loncar, Elisabeth C. McGowan, Stephen J. Sheinkopf, Brian S. Carter, Jennifer Check, Jennifer B. Helderman, Charles R. Neal, Lynne M. SmithImportance
Public concern and speculation have emerged around a possible link between neonatal male circumcision (NMC) and autism spectrum disorder (ASD). Evidence is limited and inconsistent.
Objective
To examine associations between NMC and child ASD and autism-related traits and behaviors.
Design, Setting, and Participants
This prospective cohort study was conducted among cohort sites participating in the Environmental Influences on Child Health Outcomes (ECHO) Cohort between February 2003 and September 2025. Statistical analyses were conducted from November 2025 to February 2026. The analysis included male, singleton children with data on NMC status and child ASD.
Exposure
NMC status within 28 days of birth at a medical facility.
Main outcomes and Measures
ASD diagnosis was based on parent report of diagnosis by a medical professional or documentation of criterion standard clinical assessments. Social Responsiveness Scale (SRS-2) T-scores assessed the presence and distribution of autism traits, and
Results
The sample included 2771 male children from 14 ECHO sites, of whom 1840 (66%) were circumcised before hospital discharge, and 192 (7%) had an autism diagnosis. Among 1840 circumcised males, 108 (6%) had autism, compared with 84 of 931 uncircumcised males (9%). Mean (SD) age at autism diagnosis was 3.8 (2.2) years. Among circumcised males, 31 (4%) were administered acetaminophen during the procedure, and 128 (7%) within the 30 days after birth. After adjusting for confounders, there was no association between NMC and ASD diagnosis (odds ratio [OR], 0.83; 95% CI, 0.59-1.17). After stratification by region, preterm birth, and neonatal intensive care unit admission, an inverse or no association was observed between NMC and ASD diagnosis. Adjusted analyses showed no associations between NMC and SRS-2 continuous (β = −0.62; 95% CI, −1.46 to 0.22) or binary (OR, 0.75; 95% CI, 0.48-1.15) T-scores. Similarly, no associations were observed between NMC and CBCL 1.5/5 continuous (β = 0.01; 95% CI, −0.54 to 0.56) or binary (OR, 1.30; 95% CI, 0.75-2.26) T-scores. Overall, inverse or no associations were observed across all strata for SRS-2 and CBCL 1.5/5 outcomes.
Conclusions and Relevance
This cohort study yielded no evidence that NMC was associated with ASD risk, whether assessed by parent report of medical professional diagnosis or validated instruments measuring autism-related traits and behavior. These findings may provide reassurance for families who are considering or have elected NMC for their child.