AUTISM SPECTRUM DISORDER AND POSTNATAL FACTORS: A CASE-CONTROL STUDY IN BRAZIL

Maia, Fernanda Alves; Oliveira, Liliane Marta Mendes; Almeida, Maria Tereza Carvalho; Alves, Maria Rachel; Saeger, Vanessa Souza de Araújo; Silva, Victor Bruno da; Oliveira, Victória Spínola Duarte de; Martelli, Hercílio; Brito, Maria Fernanda Santos Figueiredo; Silveira, Marise Fagundes da

doi:10.1590/1984-0462/;2019;37;4;00006

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Original Article • Rev. paul. pediatr. 37 (4) • Oct-Dec 2019 • https://doi.org/10.1590/1984-0462/;2019;37;4;00006 linkcopy

AUTISM SPECTRUM DISORDER AND POSTNATAL FACTORS: A CASE-CONTROL STUDY IN BRAZIL

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective: To estimate the magnitude of the association between Autism Spectrum Disorder (ASD) and postnatal factors in a Brazilian population.

Methods: A case-control study was performed with 253 individuals diagnosed with ASD and 886 individuals without signs of the disorder. A semi-structured questionnaire and the multiple logistic regression model were adopted in the data analysis. To estimate the magnitude of associations, the crude and adjusted Odds Ratio (OR) was used.

Results: An association with the following factors was found: having been born with congenital malformation (OR 4.24; confidence interval of 95% - 95%CI 1.92-9.34), neonatal jaundice (OR 1.43; 95%CI 1.01-2.02), absence of crying at birth and seizure episode in childhood (OR 5.75; 95%CI 3.37-9.81). The magnitude of the association was higher in the children/adolescents who had two or more postnatal complications (OR 6.39; 95%CI 4.10-10.00).

Conclusions: The findings of the present study suggest that malformation, neonatal jaundice, absence of crying at birth and seizure episodes in childhood are important factors to be considered when studying the etiology of ASD.

Keywords: Autistic disorder; Risk factors; Child; Infant, newborn

Variables	Case (n=253)	Control (n=886)	OR_crude (95%CI)	p-value*
Variables	n (%)	n (%)	OR_crude (95%CI)	p-value*
Characteristics of the newborn
Gender
Male	203 (80.2)	449 (50.7)	3.95 (2.82-5.53)	<0.001
Female	50 (19.8)	437 (49.3)	Reference	<0.001
Pre-term (<37 weeks)
Yes	45 (17.8)	111 (12.5)	1.41 (0.97-2.06)	0.071
No	208 (82.2)	775 (87.5)	Reference	0.071
Low weight at birth (<2,500 g)
Yes	40 (15.8)	93 (10.5)	1.60 (1.07-2.39)	0.020
No	213 (84.2)	793 (89.5)	Reference	0.020
Very low weight at birth (<1,500 g)
Yes	13 (5.1)	14 (1.6)	3.37 (1.57-7.27)	0.001
No	240 (94.9)	872 (98.4)	Reference	0.001
Weight/gestational age
SGA	15 (5.9)	23 (2.6)	2.33 (1.19-4.56)	0.013
LGA	44 (17.4)	169 (19.1)	0.93 (0.65-1.35)	0.705
Normal	194 (76.7)	694 (78.3)	Reference
Fetal distress
Yes	50 (19.8)	82 (9.3)	2.42 (1.65-3.55)	<0.001
No	203 (80.2)	804 (90.7)	Reference	<0.001
Congenital malformation
Yes	20 (7.9)	16 (1.8)	4.67 (2.38-9.15)	<0.001
No	233 (92.1)	870 (98.2)	Reference	<0.001
Jaundice
Yes	76 (30.0)	188 (21.2)	1.595 (1.65-2.18)	0.003
No	177 (70.0)	698 (78.8)	Reference	0.003
Anemia
Yes	18 (7.1)	37 (4.2)	1.76 (0.98-3.14)	0.054
No	235 (92.9)	849 (95.8)	Reference	0.054
Infection
Yes	35 (13.8)	63 (7.1)	2.10 (1.35-3.25)	0.001
No	218 (86.2)	823 (92.9)	Reference	0.001
Fever
Yes	34 (13.4)	70 (7.9)	1.81 (1.17-2.80)	0.007
No	219 (86.6)	816 (92.1)	Reference	0.007
Admission to the NICU
Yes	43 (17.0)	62 (7.0)	2.72 (1.79-4.13)	<0.001
No	210 (83.0)	824 (93.0)	Reference	<0.001
Absence of crying at birth
Yes	44 (17.4)	63 (7.1)	2.75 (1.81-4.16)	<0.001
No	209 (82.6)	823 (92.9)	Reference	<0.001
Difficulty initiating breathing
Yes	81 (32.0)	141 (15.9)	2.49 (1.81-3.43)	<0.001
No	172 (68.0)	745 (84.1)	Reference	<0.001
Oxygen administration
Yes	80 (31.6)	174 (19.6)	1.89 (1.38-2.59)	<0.001
No	173 (68.4)	712 (80.4)	Reference	<0.001
Hypoxia
Yes	60 (23.7)	114 (12.9)	2.11 (1.48-2.99)	<0.001
No	193 (76.3)	772 (87.1)	Reference	<0.001

Variables	Case (n=253)	Control (n=886)	OR_crude (95%CI)	p-value*
Variables	n (%)	n (%)	OR_crude (95%CI)	p-value*
Events occurring in childhood
Surgery
Yes	52 (20.6)	143 (16.1)	1.34 (0.94-1.91)	0.100
No	201 (79.4)	743 (83.9)	Reference	0.100
Epilepsy
Yes	18 (7.1)	2 (0.2)	33.86 (7.80-146.94)	<0.001
No	235 (92.9)	884 (99.8)	Reference	<0.001
Seizure episodes
Yes	50 (19.8)	35 (4.0)	5.99 (3.79-9.47)	<0.001
No	203 (80.2)	851 (96.0)	Reference	<0.001
Traumatic brain injury
Yes	19 (7.5)	22 (2.5)	3.19 (1.70-5.99)	<0.001
No	234 (92.5)	864 (97.5)	Reference	<0.001
Nervous system inflammation
Yes	9 (3.6)	14 (1.6)	2.30 (0.98-5.37)	0.049
No	244 (96.4)	872 (98.4)	Reference	0.049

Variables	OR_adjusted (95%CI)	p-value*
Birth weight/gestational age
SGA	2.08 (0.93-4.65)	0.073
LGA	0.78 (0.52-1.17)	0.237
AGA	Reference
Congenital malformation
Yes	4.24 (1.92-9.34)	<0.001
No	Reference
Jaundice
Yes	1.43 (1.01-2.02)	0.048
No	Reference
Presence of neonatal infection
Yes	1.58 (0.94-2.64)	0.084
No	Reference
Absence of crying at birth
Yes	1.97 (1.20-3.23)	0.007
No	Reference
Seizure episodes
Yes	5.75 (3.37-9.81)	<0.001
No	Reference

Number of complications	Case (n=253)	Control (n=886)	OR_crude (95%CI)	p-value	OR_adjusted (IC95%)	p-value
Number of complications	n (%)	n (%)	OR_crude (95%CI)	p-value	OR_adjusted (IC95%)	p-value
1	86 (34.0)	272 (30.7)	1.82 (1.33-2.50)	<0.001	1.71 (1.22-2.38)	0.002
≥2	62 (24.5)	54 (6.1)	8.16 (5.12-12.92)	<0.001	6.39 (4.10-10.00)	<0.001
None	105 (41.5)	560 (63.2)	Reference

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Sociedade de Pediatria de São Paulo R. Maria Figueiredo, 595 - 10o andar, 04002-003 São Paulo - SP - Brasil, Tel./Fax: (11 55) 3284-0308; 3289-9809; 3284-0051 - São Paulo - SP - Brazil
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[TFN1] 95%CI: 95% confidence interval; *chi-square test; SGA: small for gestational age; LGA: large for gestational age; NICU: Neonatal Intensive Care Unit.