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Neonatal risk factors associated with autism spectrum disorders: an umbrella review
Amir Mohammad Salehi1, Erfan Ayubi2, Salman Khazaei3
1Student Research Committee, Hamadan University of Medical Sciences School of Medicine, Hamadan, Iran.
Insights
Neonatal risk factors like congenital heart disease, macrosomia, low birth weight, jaundice, and male sex are associated with autism spectrum disorder (ASD). Early screening is recommended for infants with these risk factors.
Area of Science:
- Neurodevelopmental disorders
- Pediatric medicine
- Genetics and epigenetics
Background:
- Autism spectrum disorder (ASD) is a complex neurodevelopmental condition characterized by social communication deficits and repetitive behaviors.
- Identifying early risk factors is crucial for timely intervention and support.
Purpose of the Study:
- To conduct an umbrella review of meta-analyses and systematic reviews.
- To assess neonatal risk factors associated with the development of autism spectrum disorder.
Main Methods:
- Systematic search of international databases (PubMed, Scopus, Web of Science) up to April 2022.
- Utilized a random-effects model to calculate odds ratios (OR) and 95% confidence intervals (CI).
- Assessed study quality using the A Measurement Tool to Assess Systematic Reviews (AMSTAR2) checklist.
Main Results:
- Included 6 meta-analyses encompassing 207,221 children with ASD and over 22 million neurotypical children.
- Suggestive evidence linked congenital heart disease, macrosomia, low birth weight, very low birth weight, small for gestational age, jaundice, male sex, and low 1-minute Apgar scores to increased ASD risk.
- Methodological quality of included meta-analyses varied, with 3 rated as critically low, 2 as low, and 1 as moderate.
Conclusions:
- Several neonatal factors are associated with an increased risk of autism spectrum disorder.
- Clinicians should consider these identified risk factors during pediatric screenings.
- Further research may be needed to clarify the causal pathways and refine risk assessment.
Background:
Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by severe social communication deficits and stereotypical repetitive behaviors.
Purpose:
This umbrella review assessed neonatal risk factors associated with ASD using meta-analyses and systematic reviews.
Methods:
We conducted a systematic search of interna- tional databases including PubMed, Scopus, and Web of Science for studies published through April 2022 utilizing pertinent keywords. A random-effects model was used to calculate the odds ratio (OR) and 95% confidence interval (CI). Substantial heterogeneity was considered at values of I2≥50%. A quality assessment of the included studies was performed using the A MeaSurement Tool to Assess Systematic Reviews (AMSTAR2) checklist.
Results:
A total of 207,221 children with ASD and 22,993,128 neurotypical children were included. Six meta- analyses were included in this umbrella review. The factors of congenital heart disease (OR, 1.35; 95% CI, 1.17-1.52), macrosomia (OR, 1.11; 95% CI, 1.05-1.18), low birth weight (OR, 1.63; 95% CI, 1.48-1.81), very low birth weight (OR, 2.25; 95% CI, 1.79-2.83), small for gestational age (OR, 1.17; 95% CI, 1.09-1.24), jaundice (OR, 1.74; 95% CI, 1.42- 2.12), male sex (OR, 1.47; 95% CI, 1.39-1.55) and 1-minute Apgar score <7 (OR, 1.40; 95% CI, 1.26-1.55) were graded as suggestive evidence (class III). Only 3 studies reported heterogeneity (I2<50%). Based on the AMSTAR2 analysis, the methodological quality was critically low in 3 meta- analyses, low in 2, and moderate in 1.
Conclusion:
Based on these results, clinicians should consider the risk factors for ASD and screen children in clinics.
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