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Prematurity and autism: a dose-response relationship across gestational age

Ariel Israel1,2, Francis B Mimouni3,4, Shlomo Vinker3,5

  • 1Leumit Research Institute and Department of Pediatrics, Leumit Health Services, Tel Aviv, Israel. arielisrael@tauex.tau.ac.il.

Journal of Perinatology : Official Journal of the California Perinatal Association
|April 14, 2026
PubMed

Insights

Autism spectrum disorder (ASD) risk significantly increases with earlier gestational age at birth. This dose-response relationship highlights prematurity as a key factor in ASD development.

Area of Science:

  • Perinatal health
  • Neurodevelopmental disorders
  • Epidemiology

Background:

  • Autism spectrum disorder (ASD) is a complex neurodevelopmental condition.
  • Gestational age at birth is a known factor influencing infant health outcomes.
  • Understanding the precise relationship between prematurity and ASD risk is crucial for early intervention.

Purpose of the Study:

  • To investigate the association between gestational age at birth and the risk of developing autism spectrum disorder (ASD).
  • To quantify the dose-response relationship between decreasing gestational age and ASD incidence.

Main Methods:

  • A retrospective cohort study utilized ICD-10 codes to identify ASD cases (n=1861) born between 2011-2023.
  • Exact and propensity-score matching were employed to select ten controls per case, balancing key demographic and socioeconomic factors.
  • Gestational age was categorized, and conditional logistic regression analyzed associations with ASD risk.

Main Results:

  • A progressive increase in ASD risk was observed with greater prematurity.
  • Compared to term births (37-42 weeks), adjusted odds ratios for ASD increased with earlier gestational ages.
  • Significantly elevated risks were noted for infants born at 36 weeks (1.37), 34-35 weeks (1.67), 32-33 weeks (2.14), 28-31 weeks (2.95), and below 28 weeks (4.37).

Conclusions:

  • Earlier gestational age is significantly associated with an increased risk of autism spectrum disorder.
  • The findings demonstrate a clear dose-response relationship, where greater prematurity corresponds to higher ASD risk.
  • These results underscore the importance of monitoring and support for infants born preterm regarding neurodevelopmental outcomes.
Abstract

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