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Autism spectrum disorders in extremely preterm infants and placental pathology findings: a matched case-control study
Imran N Mir1, Stormi P White2, L Steven Brown3
1Department of Pediatrics, Division of Neonatal-Perinatal Medicine, University of Texas Southwestern Medical School, Dallas, TX, USA. imran.mir@utsouthwestern.edu.
Insights
Autism spectrum disorder (ASD) is more common in preterm infants. This study found that multiple placental lesions are linked to a higher risk of ASD in extremely preterm infants (born ≤28 weeks gestational age).
Area of Science:
- Perinatal Medicine
- Neurodevelopmental Disorders
- Pathology
Background:
- Autism spectrum disorder (ASD) prevalence is significantly higher in preterm (PT) infants (born ≤28 weeks gestational age) compared to the general population.
- The association between placental pathology and ASD in PT infants remains understudied.
Purpose of the Study:
- To investigate the relationship between placental pathologic lesions and the occurrence of ASD in PT infants born ≤28 weeks gestational age.
- To determine if the complexity of placental lesions correlates with ASD risk in this vulnerable population.
Main Methods:
- A matched case-control study design was employed, comparing 16 infants with confirmed ASD to 48 matched controls.
- Infants were born between January 2012 and December 2015 at Parkland Hospital and matched for known ASD risk factors.
- Histological examination of placentas from all included births was conducted.
Main Results:
- Infants with ASD exhibited a 2-fold higher incidence of multiple placental pathologic lesions compared to controls (69% vs. 33%, P=0.01).
- No significant association was found between single placental lesions and ASD in PT infants (31% vs. 43%, P=0.1).
Conclusions:
- An association exists between the increasing complexity of placental histologic lesions and the risk of ASD in extremely preterm infants (≤28 weeks GA).
- Placental pathology findings offer valuable insights into prenatal factors contributing to ASD development in PT infants.
- This research highlights the importance of placental examination for understanding antenatal insults and their correlation with adverse postnatal outcomes in PT infants.
Background:
The prevalence of autism spectrum disorders (ASD) is 5-fold higher in preterm (PT) infants born ≤28 weeks gestational age (GA) as compared to the general population. The relationship between placental pathologic lesions and ASD in PT infants has not been studied.
Objectives:
The objective of this study was to determine the association of placental pathology with the occurrence of ASD in PT infants born ≤28 weeks GA.
Study Design:
A matched case-control study to identify confirmed ASD cases (n = 16) and matched controls (n = 48) born at Parkland Hospital between January 2012 and December 2015. Patients were matched using known variables associated with increased risk of ASD in PT infants. Placental histology from all births was reviewed.
Results:
Children with ASD had 2-fold greater incidence of multiple placental pathologic lesions vs. matched controls [11/16 (69%) vs.16/48 (33%), respectively; P = 0.01]. In contrast, single placental pathologic lesions were not associated with ASD [5/16 (31%) vs. 21/48 (43%), respectively; P = 0.1].
Conclusions:
In this study, we have demonstrated an association between the increasing complexity of histologic placental lesions and the later risk for ASD in infants born ≤28 weeks GA. Thus, placental pathology findings may be valuable in further understanding the prenatal pathologic processes underlying ASD in PT infants.
Impact:
PT infants with ASD have a 2-fold greater incidence of multiple placental pathologies. This is the first study to report an association between the complexity of histologic placental lesions and later risk of ASD in infant born extremely PT (i.e., ≤28 weeks GA). This study reiterates the importance of examining placental pathologic lesions, since placental evidence of antenatal insults correlates with postnatal morbidities and mortality in PT infants.
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