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Risk Factors for Autism Spectrum Disorder in Individuals Born Preterm: A Systematic Review and Meta-Analysis of
Bo Yang1, Nina Zaks2, Eero Kajantie3,4,5,6
1JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China.
Insights
Preterm children face higher autism spectrum disorder (ASD) risks. Male sex is a confirmed risk factor, with low birth weight showing potential association. More research is needed to clarify ASD causes in preterm infants.
Area of Science:
- Neurodevelopmental Disorders
- Perinatal Medicine
- Epidemiology
Background:
- Preterm birth is linked to increased autism spectrum disorder (ASD) risk.
- Determinants of ASD in preterm infants are not well understood.
- This study systematically reviews risk factors for ASD in preterm populations.
Purpose of the Study:
- To summarize population-based literature on ASD risk factors in preterm-born individuals.
- To identify consistent risk factors through systematic review and meta-analysis.
- To highlight knowledge gaps in ASD etiology for preterm infants.
Main Methods:
- Systematic search of Ovid MEDLINE, Embase, and Web of Science databases.
- Inclusion of 19 population-based studies (cohort, case-control, cross-sectional).
- Meta-analysis of risk factors examined in at least two studies, following PRISMA guidelines.
Main Results:
- Male sex identified as a significant risk factor for ASD in preterm infants (RR 3.04).
- Low birth weight suggested a potential association with ASD.
- Neonatal jaundice showed no clear link; other factors examined in limited studies.
Conclusions:
- Significant knowledge gaps persist regarding ASD risk factors in preterm infants.
- Male sex is the only consistent risk factor identified.
- Further research is crucial to understand ASD etiology differences between preterm and term-born individuals.
Background:
Preterm children are at an increased risk of autism spectrum disorder (ASD), although the determinants of ASD among them remain unclear. In this systematic review and meta-analysis, we summarize the population-based literature on ASD risk factors in preterm-born individuals.
Methods:
We searched Ovid MEDLINE, Embase, and Web of Science through September 2023 for population-based studies on ASD risk factors in preterm cohorts (<37 weeks' gestation). From 3921 articles, 19 met inclusion criteria. Registered in PROSPERO and following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, data were extracted and analyzed using fixed and random effects meta-analysis models. Primary outcomes included ASD risk factors, pooled when consistently examined in at least 2 studies.
Results:
The qualitative synthesis included 16 cohort studies, 2 case-control studies, and 1 cross-sectional study, while 3 cohort studies were included in the meta-analysis. Sample sizes ranged from 410 to 515,789. Male sex was the only risk factor eligible for meta-analysis and was associated with increased risk of ASD (relative risk 3.04; 95% CI, 2.02-4.57). Low birth weight suggested a potential positive association with ASD, while neonatal jaundice showed no clear link. Pooled estimates were unavailable for these exposures due to heterogeneity in exposure definitions and effect measures. All other risk factors were examined in two or fewer studies.
Conclusions:
Significant knowledge gaps remain regarding the risk of ASD in individuals born preterm. The only consistent risk factor identified is male sex, with potential links to low birth weight. To better understand the differences in ASD etiology between preterm and term-born individuals, further research is crucial.
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