Prenatal risk factors for autism: comprehensive meta-analysis.
BACKGROUND
The aetiology of autism is unknown, although prenatal exposures have been the focus of epidemiological research for over 40 years.


OBJECTIVE
To provide the first quantitative review and meta-analysis of the association between maternal pregnancy complications and pregnancy-related factors and risk of autism.


METHODS
PubMed, Embase and PsycINFO databases were searched for epidemiological studies that examined the association between pregnancy-related factors and autism. Forty studies were eligible for inclusion in the meta-analysis. Summary effect estimates were calculated for factors examined in multiple studies.


RESULTS
Over 50 prenatal factors have been examined. The factors associated with autism risk in the meta-analysis were advanced parental age at birth, maternal prenatal medication use, bleeding, gestational diabetes, being first born v. third or later, and having a mother born abroad. The factors with the strongest evidence against a role in autism risk included previous fetal loss and maternal hypertension, proteinuria, pre-eclampsia and swelling.


CONCLUSIONS
There is insufficient evidence to implicate any one prenatal factor in autism aetiology, although there is some evidence to suggest that exposure to pregnancy complications may increase the risk.
Gardener
Hannah
H
Department of Neurology, University of Miami Miller School of Medicine, Post Office Box 016960 (M712), Miami, FL 33101, USA. hgardener@med.miami.edu
Spiegelman
Donna
D
Buka
Stephen L
SL
D001321:Autistic Disorder / Q000209:etiology*; D001722:Birth Order; D016640:Diabetes, Gestational; D004641:Emigration and Immigration; D005260:Female; D005311:Fetal Hypoxia; D006801:Humans; D010290:Parents; D011247:Pregnancy; D011248:Pregnancy Complications; D015995:Prevalence; D012044:Regression Analysis; D012307:Risk Factors