School of Public Health, Xinxiang Medical University, 601 Jinsui Road, Xinxiang, Henan, 453003, China.
Eur Child Adolesc Psychiatry. 2024 Jul;33(7):2035-2049. doi: 10.1007/s00787-022-02078-4. Epub 2022 Sep 6.
We aimed to comprehensively pool the prevalence of autism spectrum disorder (ASD) diagnosis by birth weight, gestational age, and size for gestational age. PubMed, EMBASE, Web of Science, Ovid PsycINFO, and Cochrane Library were searched up to December 22, 2021. We pooled data using the random-effects model and quantified heterogeneity using the I statistic. Of 66 643 records initially identified, 75 studies were included in the meta-analysis. The pooled prevalence estimates of ASD diagnosis are as follows: very-low-birth weight, 3.1% (912 ASD/66,445 individuals); low-birth weight, 2.3% (5672 ASD/593,927 individuals); normal-birth weight, 0.5% (17,361 ASD/2,378,933 individuals); high-birth weight, 0.6% (4505 ASD/430,699 individuals); very preterm, 2.8% (2113 ASD/128,513 individuals); preterm, 2.1% (19 672 ASD/1 725 244 individuals); term, 0.6% (113,261 ASD/15,297,259 individuals); postterm, 0.6% (9419 ASD/1,138,215 individuals); small-for-gestational-age, 1.9% (6314 ASD/796,550 individuals); appropriate-for-gestational-age, 0.7% (21,026 ASD/5,936,704 individuals); and large-for-gestational-age, 0.6% (2607 ASD/635,666 individuals). Compared with the reference prevalence (those in normal-birth weight, term, and appropriate-for-gestational-age individuals), the prevalence estimates of ASD diagnosis in very-low-birth weight, low-birth weight, very preterm, preterm, and small-for-gestational-age individuals increased significantly, while those in high-birth weight, postterm, and large-for-gestational-age individuals did not change significantly. There were geographical differences in the prevalence estimates. This meta-analysis provided reliable estimates of the prevalence of ASD diagnosis by birth weight, gestational age, and size for gestational age, and suggested that low-birth weight (especially very-low-birth weight), preterm (especially very preterm), and small-for-gestational-age births, rather than high-birth weight, postterm, and large-for-gestational-age births, were associated with increased risk of ASD diagnosis. However, in view of marked between-study heterogeneity in most conditions, unknown effects of certain important confounders associated with ASD due to limited information in original articles, and included studies from a relatively small number of countries, the findings of this study should be interpreted with caution.
我们旨在综合汇总不同出生体重、胎龄和小于胎龄儿的自闭症谱系障碍（ASD）诊断患病率。检索了 PubMed、EMBASE、Web of Science、Ovid PsycINFO 和 Cochrane Library，检索时间截至 2021 年 12 月 22 日。我们使用随机效应模型汇总数据，并使用 I 统计量量化异质性。在最初确定的 66643 条记录中，有 75 项研究纳入了荟萃分析。ASD 诊断的汇总患病率估计如下：极低出生体重，3.1%（66445 人中 312 例）；低出生体重，2.3%（593927 人中 5672 例）；正常出生体重，0.5%（2378933 人中 17361 例）；高出生体重，0.6%（430699 人中 4505 例）；极早产，2.8%（128513 人中 2113 例）；早产，2.1%（1725244 人中 19672 例）；足月产，0.6%（15297259 人中 113 例）；过期产，0.6%（1138215 人中 9419 例）；小于胎龄儿，1.9%（796550 人中 6314 例）；适于胎龄儿，0.7%（5936704 人中 21026 例）；大于胎龄儿，0.6%（635666 人中 2607 例）。与参考患病率（正常出生体重、足月产和适于胎龄儿）相比，极低出生体重、低出生体重、极早产、早产和小于胎龄儿的 ASD 诊断患病率显著增加，而高出生体重、过期产和大于胎龄儿的 ASD 诊断患病率无显著变化。患病率估计存在地域差异。这项荟萃分析提供了可靠的出生体重、胎龄和小于胎龄儿的 ASD 诊断患病率估计，并表明低出生体重（尤其是极低出生体重）、早产（尤其是极早产）和小于胎龄儿出生与 ASD 诊断风险增加有关，而不是高出生体重、过期产和大于胎龄儿出生。然而，鉴于大多数情况下存在明显的研究间异质性、由于原始文章中有限的信息而导致某些与 ASD 相关的重要混杂因素的未知影响，以及纳入的研究来自相对较少的国家，因此应谨慎解释本研究的结果。
