Prenatal Environment and Perinatal Factors Associated with Autism Spectrum Disorder

Jianjun Ou1,2,3, Yidong Shen1, Yamin Li 4, Guanglei Xun5, Huaqing Liu6, Yiqun He7, Hui Guo3, Renrong Wu1, Claude Hughes8, Kun Xia3, Jingping Zhao1, Fengyu Zhang1,2,6

1 Department of Psychiatry & Mental Health Institute of the Second Xiangya Hospital, Central South University; The China National Clinical Research Center for Mental Health Disorders; National Technology Institute of Psychiatry; Key Laboratory of Psychiatry and Mental Health of Hunan Province, Changsha, Hunan, China.

2 Global Clinical and Translational Research Institute, Bethesda, Maryland, USA.

3 Center for Medical Genetics and School of Life Sciences, Central South University, Changsha, Hunan, China.

4 Clinical Nursing Teaching and Research Section, the Second Xiangya Hospital, Central South University, Hunan, China.

5 Shandong Mental Health Center, Jinan, Shandong, China.

6 Peking University Clinical Medical School and Beijing Huilongguan Hospital, Changping District, Beijing, China.

7 The First Department of Clinical Psychosomatic Medicine of the Second Affiliated Hospital of Xinxiang Medical University, Xinxiang, Henan, China.

8 Therapeutic Science and Strategy Unit, IQVIA, Research Triangle Park, NC; Department of Obstetrics and Gynecology, Duke University Medical Center. Morrisville, NC, USA.

Received March 19, 2019; Accepted July 31, 2019


Background: Both genetic and epidemiological studies have indicated that environmental factors play an essential role in the development of autism spectrum disorder (ASD). We conducted this study to identify maternal exposure to environmental factors, in particular during the fetal development or perinatal period, associated with ASD.

Methods: Two independent samples of children with ASD and typical developed (TD) were from distinct regions in China. Multiple logistic regression analysis was performed to identify factors associated with ASD in each sample and then in the combined sample.

Results: Five factors were consistently associated with ASD in both samples. In the combined sample, maternal chemical exposure (odds ratio [OR] =4.50; 95% CI: 2.38-8.52), use of medication (OR = 3.19; 95% CI: 2.19-4.65), maternal infection (OR = 2.68; 95% CI: 1.99-3.61), threatened abortion (OR = 2.37; 95% CI: 1.61-3.50), and induced abortion before having the child (OR = 2.07; 95% CI: 1.65-2.60) showed strong associations with ASD; moreover, five factors explained 10-15% of the variation in the risk of ASD. A significant interaction between maternal infection and the use of medication during pregnancy was consistently detected in both independent and combined samples together.

Conclusion: Two novel risk factors of maternal chemical exposure and induced abortion may have important implications for understanding the etiology of ASD, particularly in China. Prospective studies are needed to validate these findings, and necessary interventions are recommended to reduce the risk of ASD.


Autism spectrum disorder, chemical exposure, induced abortion, maternal infection

Copyright 2019 by the author(s). Licensee Global Clinical and Translational Research Institute, Bethesda, MD. This is an open-access article distributed under the terms and conditions of the Creative Commons Attribution License (CCBY4.0, /licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium provided the original work is properly cited.

How to cite this article:

Ou, J, Shen Y, Li Y, Xun G, Liu H, He Y, Guo H, Wu R, Hughes C, Xia K, Zhao J, Zhang F. Prenatal Environment and Perinatal Factors Associated with Autism Spectrum Disorder. Glob Clin Transl Res. 2019; 1(3): 100-108. doi:10.36316/gcatr.01.0015


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