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BMC Psychiatry
Published in: BMC Psychiatry 1/2024

Open Access 01-12-2024 | Autism Spectrum Disorder | Research

Prenatal, perinatal and parental risk factors for autism spectrum disorder in China: a case- control study

Authors: Jia-jia Yuan, Ya-nan Zhao, Xing-yu Lan, Yong Zhang, Rong Zhang

Published in: BMC Psychiatry | Issue 1/2024

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Abstract

Background

Autism spectrum disorder (ASD) is heritable neurodevelopmental disorders (NDDs), but environmental risk factors have also been suggested to a play a role in its development. Prenatal, perinatal and parental factors have been associated with an increased risk of ASD in children. The aim of the present study was to explore the prenatal, perinatal, and parenting risk factors in children with autism spectrum disorder (ASD) from Beijing, China by comparing them with typically developing (TD) children.

Methods

A sample of 151 ASD children’s parents who from rehabilitation institutions in Beijing were enrolled in this study, and an additional 151 children from kindergartens in Beijing were recruited as a control group (child age: mean = 4.4 years). TD children were matched according to age, sex and maternal education. We explored the maternal AQ (Autism Spectrum Quotient) scores (mean:19.40-19.71, no significant difference between two groups) to referring the genetic baseline. This study evaluated 17 factors with unadjusted and adjusted analyses.

Results

Birth asphyxia was associated with a more than a thirteen-fold higher risk of ASD (adjusted odds ratio (AOR) = 13.42). Breastfeeding difficulties were associated with a higher risk of ASD(AOR = 3.46). Parenting influenced the risk of ASD, with low responding (LR) and harsh or neglectful parenting associated with a higher risk of ASD in offspring (AOR = 2.37 for LR, AOR = 3.42 for harsh parenting and AOR = 3.01 for neglectful parenting). Maternal fever during pregnancy was associated with a higher risk of ASD in offspring (AOR = 3.81).

Conclusions

Many factors were associated with ASD in offspring. Further assessment is needed to elucidate the role of modifiable environmental factors to inform prevention strategies.
Literature
1.
American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Arlington, VA: Author; 2013.CrossRef
2.
Hallmayer J, Cleveland S, Torres A, Phillips J, Cohen B, et al. Genetic heritability and Shared Environmental factors among twin pairs with autism. Arch Gen Psychiatry. 2011;68:1095–102.PubMedPubMedCentralCrossRef
3.
Froehlich-Santino W, Londono Tobon A, Cleveland S, et al. Prenatal and perinatal risk factors in a twin study of autism spectrum disorders. J Psychiatr Res. 2014;54:100–8.PubMedPubMedCentralCrossRef
4.
Dodds L, Fell DB, Shea S, et al. The role of prenatal, obstetric and neonatal factors in the development of autism. J Autism Dev Disord. 2011;41:891–902.PubMedCrossRef
5.
Carlsson T, Molander F, Taylor MJ, Jonsson U, Bölte S. Early environmental risk factors for neurodevelopmental disorders—a systematic review of twin and sibling studies. Dev Psychopathol. 2020;24:1–48.
6.
7.
Schendel D, Bhasin TK. Birth weight and gestational age characteristics of children with autism, including a comparison with other developmental disabilities. Pediatrics. 2008;121:1155–64.PubMedCrossRef
8.
Rossignol DA, Frye RE. A review of research trends in physiological abnormalities in autism spectrum disorders: Immune dysregulation, inflammation, oxidative stress, mitochondrial dysfunction and environmental toxicant exposures. Mol Psychiatry. 2012;17:389–401.PubMedCrossRef
9.
Visser JC, Rommelse N, Vink L, et al. Narrowly versus broadly defined autism spectrum disorders: differences in pre- and perinatal risk factors. J Autism Dev Disord. 2013;43:1505–16.PubMedCrossRef
10.
11.
Szatmari P. Is autism, at least in part, a disorder of fetal programming? Arch Gen Psychiatry. 2011;68:1091–2.PubMedCrossRef
12.
Rai D, Golding J, Magnusson C, et al. Prenatal and early life exposure to stressful life events and risk of autism spectrum disorders: Population-based studies in Sweden and England. PLoS ONE. 2012;7:e38893.ADSPubMedPubMedCentralCrossRef
13.
Croen LA, Grether JK, Yoshida CK, Odouli R, Hendrick V. Antidepressant use during pregnancy and childhood autism spectrum disorders. Archives Genetic Psychiatry. 2011;68:1104–12.CrossRef
14.
Leavey A, Zwaigenbaum L, Heavner K, et al. Gestational age at birth and risk of autism spectrum disorders in Alberta. Can Pediatr. 2013;162:361–8.
15.
Mamidala MP, Polinedi A, Kumar P. Prenatal, perinatal and neonatal risk factors of Autism Spectrum disorder: a comprehensive epidemiological assessment from India. Res Dev Disabil. 2013;34:3004–13.PubMedCrossRef
16.
Yong Z, Dou Y, Gao Y, Xu X, et al. Prenatal, perinatal, and postnatal factors associated with autism spectrum disorder cases in Xuzhou, China. Transl Pediatr. 2021;10(3):635–46.PubMedPubMedCentralCrossRef
17.
Baumrind D. The development of instrumental competence through socialization, vol 7. University of Minnesota Press, Minnesota Symposium on Child Psychology, Minneapolis. 1973.
18.
Watson LR, Crais ER, Baranek GT, et al. Parent-mediated intervention for one-year-olds screened as at-risk for autism spectrum disorder: a randomized controlled trial. J Autism Dev Disord. 2017;47:3520–40.PubMedCrossRef
19.
Yoder P, Watson LR, Lambert W. Value-added predictors of expressive and receptive language growth in initially nonverbal preschoolers with autism spectrum disorders. J Autism Dev Disord. 2015;45:1254–70.PubMedPubMedCentralCrossRef
20.
Davis PH, Elsayed H, Crais ER, et al. Caregiver responsiveness as a mechanism to improve social communication in toddlers: secondary analysis of a randomized controlled trial. Autism Res. 2022;15:366–78.PubMedCrossRef
21.
Schuiringa H, van Nieuwenhuijzen M, Orobio de Castro B, Matthys W. Parenting and parent-child relationship in families of children with mild to borderline intellectual disabilities and externalizing behavior. Res Dev Disabil. 2015;36:1–12.PubMedCrossRef
22.
Flouri E, Midouhas E. Environmental adversity and children’s early trajectories of problem behavior: the role of harsh parental discipline. J Fam Psychol. 2017;31:234–43.PubMedCrossRef
23.
Bilder D, Pinborough-Zimmerman J, Miller J, McMahon W. Prenatal, perinatal, and neonatal factors associated with autism spectrum disorders. Pediatrics. 2009;123:1293–300.PubMedCrossRef
24.
25.
Bölte S, Girdler S, Marschik PB. The contribution of environmental exposure to the etiology of autism spectrum disorder. Cell Mol Life Sci. 2019;76(7):1275–97.PubMedCrossRef
26.
Wheelwright S, Auyeung B et al. Research defining the broader, medium and narrow autism phenotype among parents using the Autism Spectrum Quotient Molecular Autism. 2010; 1:10.
27.
More RP, Warrier V, Brunel H, et al. Identifying rare genetic variants in 21 highly multiplex autism families: the role of diagnosis and autistic traits. Mol Psychiatry. 2023;28(5):2148–57.PubMedPubMedCentralCrossRef
28.
Thorsen M, Bilenberg N, Thorsen L, Michel TM. Oxidative stress in adults with Autism Spectrum disorder: a Case Control Study. J Autism Dev Disord. 2022;52(1):275–82.PubMedCrossRef
29.
Shao N, Zhao M, Wei XD Case-control study on the risk factors of autistic children during early life in Hefei. Chin J Child Health Care., Sandin S, Hultman CM, Kolevzon A et al. Advancing maternal age is associated with increasing risk for autism: a review and meta-analysis. J Am Acad Child Adolesc Psychiatry, 2012; 51:477–86.
30.
31.
Baron-Cohen S, Wheelwright S, Skinner R, et al. The autism-spectrum quotient (AQ): evidence from Asperger syndrome/ high functioning autism, male and female, scientists and mathematics. J Autism Dev Disord. 2001;31:5–17.PubMedCrossRef
32.
Bishop DVM, Maybery M, Maley A, et al. Using selfreport to identify the broad phenotype in parents of children with autistic spectrum disorders: a study using the autism-spectrum quotient. J Child Psychol Psychiatry. 2004;45:1431–6.PubMed
33.
Baron-Cohen S, Hoekstra RA, Knickmeyer R, Wheelwright S. The autism-spectrum quotient (AQ)—Adolescent version. J Autism Dev Disord. 2006;36:343–50.PubMedCrossRef
34.
35.
Wilkerson DS, Volpe AG, Dean RS, Titus JB. Perinatal complications as predictors of infantile autism. Int J Neurosci. 2002;112:1085–98.PubMedCrossRef
36.
Zerbo O, Iosif AM, Walker C, et al. Is maternal influenza or fever during pregnancy Associated with Autism or Developmental Delays? Results from the CHARGE (CHildhood Autism risks from Genetics and Environment) Study. J Autism Dev Disord. 2013;43:25–33.PubMedPubMedCentralCrossRef
37.
38.
Manohar H, Pravallika M, Kandasamy P, et al. Role of exclusive breastfeeding in conferring Protection in Children At-Risk for Autism Spectrum Disorder: results from a sibling case-control study. J Neurosci Rural Pract. 2018;9(1):132–6.PubMedPubMedCentralCrossRef
39.
Gartner LM, Morton J, Lawrence RA, et al. Breastfeeding and the use of human milk. Pediatrics. 2005;115:496–506.PubMedCrossRef
40.
Ravi S, Chandrasekaran V, Kattimani S, Subramanian M. Maternal and birth risk factors for children screening positive for autism spectrum disorders on M-CHAT-R. Asian J Psychiatr. 2016;22:17–21.PubMedCrossRef
41.
Walker A. Breast milk as the gold standard for protective nutrients. J Pediatr. 2010;156:3–7.CrossRef
42.
Hegney D, Fallon T, O’Brien ML. Against all odds: a retrospective case-controlled study of women who experienced extraordinary breastfeeding problems. J Clin Nurs. 2008;17(9):1182–92.PubMedCrossRef
43.
Al-Farsi YM, Al-Sharbati MM, Waly MI, et al. Effect of suboptimal breast-feeding on occurrence of autism: a case-control study. Nutrition. 2012;28:e27–32.PubMedCrossRef
44.
Tseng PT, Chen YW, Stubbs B, et al. Maternal breastfeeding and autism spectrum disorder in children: a systematic review and meta-analysis. Nutr Neurosci. 2019;22(5):354–62.PubMedCrossRef
45.
Van Zeijl J, Mesman J, Van IJzendoorn MH, et al. Attachment-based intervention for enhancing sensitive discipline in mothers of 1- to 3-year-old children at risk for externalizing behavior problems: a randomized controlled trial. J Consult Clin Psychol. 2006;74:994–1005.PubMedCrossRef
46.
Haebig E, McDuffie A, Weismer SE. Brief report: parent verbal responsiveness and language development in toddlers on the autism spectrum. J Autism Dev Disord. 2013;43:2218–27.PubMedPubMedCentralCrossRef
47.
Shire S, Gulsrud A, Kasari C. Increasing responsive parent-child interactions and joint engagement: comparing the influence of parent-mediated intervention and parent psychoeducation. J Autism Dev Disord. 2016;46:1737–47.PubMedPubMedCentralCrossRef
48.
Hoeve M, Dubas JS, Eichelsheim VI, et al. The relationship between parenting and delinquency: a metaanalysis. J Abnorm Child Psychol. 2009;37:749–75.PubMedPubMedCentralCrossRef
49.
Stormshak EA, Bierman KL, McMahon RJ, Lengua LJ. Parenting practices and child disruptive behavior problems in early Elementary School. J Clin Child Psychol. 2000;29:17–29.PubMedPubMedCentralCrossRef
50.
Saito A, Matsumoto S, Sato M, et al. Relationship between parental autistic traits and parenting difficulties in a Japanese community sample. Res Dev Disabil. 2022;124:104210.PubMedCrossRef
51.
Lin X, Su X, Huang S, et al. Association between maternal parenting styles and behavioral problems in children with ASD: moderating effect of maternal autistic traits. Front Psychiatry. 2023;14:1107719.PubMedPubMedCentralCrossRef
52.
Eiden RD, Colder C, Edwards EP, Leonard KE. A longitudinal study of social competence among children of alcoholic and nonalcoholic parents: role of parental psychopathology, parental warmth, and self-regulation. Psychol Addict Behav. 2009;23:36–46.PubMedPubMedCentralCrossRef
53.
Kochanska G, Kim S. Toward a new understanding of legacy of early attachments for future antisocial trajectories: evidence from two longitudinal studies. Dev Psychopathol. 2012;24:783–806.PubMedPubMedCentralCrossRef
54.
Waters E, Cummings EM. A secure base from which to explore close relationships. Child Dev. 2000;71:164–72.PubMedCrossRef
55.
Nicolson NA. Measurement of cortisol. In Luecken LJ, Gallo LC, editors, Handbook of Physiological Research Methods in Health psychology. Thousan Oaks: Sage Publications Inc.2008.
56.
Goldman-Mellor S, Hamer M, Steptoe A. Early-life stress and recurrent psychological distress over the life course predict divergent cortisol reactivity patterns in adulthood. Psychone Uroendocrinology. 2012;37:1755–68.CrossRef
57.
McEwen BS. Sex, stress, and the hippocampus: allostasis, allostatic load, and the aging process. Neurobiol Aging. 2002;23:921–39.PubMedCrossRef
58.
Ward AJ. A comparison and analysis of the presence of family problems during pregnancy of mothers of autistic children and mothers of normal children. Child Psychiatry Hum Dev. 1990;20:279–88.PubMedCrossRef
59.
Li J, Vestergaard M, Obel C, et al. A nationwide study on the risk of autism after prenatal stress exposure to maternal bereavement. Pediatrics. 2009;123:1102–7.PubMedCrossRef
60.
Ward IL, Ward OB, Affuso JD, et al. Fetal testosterone surge: specific modulations induced in male rats by maternal stress and/or alcohol consumption. Horm Behav. 2003;43:531–9.PubMedCrossRef
61.
Zhou WZ, Ye AY, Sun ZK et al. Statistical analysis of twenty years (1993 to 2012) of data from mainland China’s first intervention center for children with autism spectrum disorder. Mol Autism. 2014; 12;5:52.
62.
Yu T, Lien YJ, Liang FW, Kuo PL. Parental socioeconomic status and autism spectrum disorder in offspring: a Population-based Cohort Study in Taiwan. Am J Epidemiol. 2021;190(5):807–16.PubMedCrossRef
63.
Schmidt RJ, Hansen RL, Hartiala J, et al. Prenatal vitamins, one-carbon metabolism gene variants, and risk for autism. Epidemiology. 2011;22(4):476–85.PubMedPubMedCentralCrossRef
64.
Hasegawa C, Kikuchi M, Yoshimura Y, et al. Broader autism phenotype in mothers predicts social responsiveness in young children with autism spectrum disorders. Psychiatry Clin Neurosci. 2015;69(3):136–44.PubMedCrossRef
65.
Modabbernia A, Sandin S, Gross R, et al. Apgar score and risk of autism. Eur J Epidemiol. 2019;34(2):105–14.PubMedCrossRef
Metadata
Title
Prenatal, perinatal and parental risk factors for autism spectrum disorder in China: a case- control study
Authors
Jia-jia Yuan
Ya-nan Zhao
Xing-yu Lan
Yong Zhang
Rong Zhang
Publication date
01-12-2024
Publisher
BioMed Central
Published in
BMC Psychiatry / Issue 1/2024
Electronic ISSN: 1471-244X
DOI
https://doi.org/10.1186/s12888-024-05643-0

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