title: Environmental factors associated with autism spectrum disorder: a scoping review for the years 2003-2013.
abstract: BACKGROUND
  The number of children diagnosed with autism spectrum disorder (ASD) has been rapidly rising in the past decade. The etiology of this disorder, however, is largely unknown, although the environmental relative to the genetic contribution is substantial. We conducted a scoping review to comprehensively assess the current state of knowledge of the environmental factors present from preconception to early life associated with ASD, and to identify research gaps.
  
  
  METHODS
  We searched electronic databases MEDLINE, PsycINFO and ERIC for articles on potential risk factors or protective factors from the physical and social environments associated with ASD and its subclassifications published between 1 January, 2003, and 12 July, 2013. We categorized articles into broad themes: chemical, physiological, nutritional and social factors, based on environmental exposure.
  
  
  RESULTS
  We identified over 50 000 publications, but after ineligible studies were screened out, 315 articles remained. Most of these studies examined physiological factors, followed closely by chemical factors, and to a much lesser extent, nutritional and social factors, associated with ASD. Despite a vast literature and many heterogeneous studies, several risk factors emerged consistently: chemical factors such as traffic-related air pollutants; physiological factors including advanced parental age, preterm birth, low birth weight, hyperbilirubinemia and clustering of pregnancy complications; and maternal immigrant status. Despite extensive research on vaccines, findings overwhelmingly demonstrate no support for an association with ASD.
  
  
  CONCLUSIONS
  The lack of consistency, temporality and specificity of associations between environmental factors and ASD remains the largest barrier to establishing causal relationships. More robust research is required to resolve inconsistencies in the literature. Future research should explore underlying mechanisms of associations between the risk factors that we identified and ASD.
authors.affiliation: Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.|Public Health Agency of Canada, Ottawa, Ontario, Canada.
authors.forename: M
authors.initials: M
authors.lastname: Ng
authors.affiliation: Institute of Population Health, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: J G
authors.initials: JG
authors.lastname: de Montigny
authors.affiliation: Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.|Public Health Agency of Canada, Ottawa, Ontario, Canada.
authors.forename: M
authors.initials: M
authors.lastname: Ofner
authors.affiliation: Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.|Public Health Agency of Canada, Ottawa, Ontario, Canada.
authors.forename: M T
authors.initials: MT
authors.lastname: Do
mesh_terms: D000067877:Autism Spectrum Disorder / Q000209:etiology*; D002648:Child; D002675:Child, Preschool; D004781:Environmental Exposure; D005260:Female; D006801:Humans; D008297:Male; D011247:Pregnancy; D011248:Pregnancy Complications; D012307:Risk Factors; D066252:Sociological Factors
keywords: ASD; autism; autism spectrum disorder; environmental exposure; etiology