National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Paediatr Perinat Epidemiol. 2023 Aug;37(6):527-535. doi: 10.1111/ppe.12998. Epub 2023 Jul 23.
Studies evaluating the association between prenatal ultrasounds and autism spectrum disorder (ASD) have largely produced negative results. Concern remains due to the rising identification of children with ASD and ultrasound use.
To evaluate the association between prenatal ultrasound use and ASD.
We used data from the Study to Explore Early Development, a multisite case-control study of preschool-aged children with ASD implemented during 2007-2012. We recruited cases from children receiving developmental disability services and randomly selected population controls from birth records. ASD case status was based on in-person standardised assessments. We stratified analyses by pre-existing maternal medical conditions and pregnancy complications associated with increased ultrasound use (ultrasound indications) and used logistic regression to model case status by increasing ultrasound counts. For pregnancies with medical record data on ultrasound timing, we conducted supplementary tests to model associations by trimester of exposure.
Among 1524 singleton pregnancies, ultrasound indications were more common for ASD cases than controls; respectively, for each group, no indications were reported for 45.1% and 54.2% of pregnancies, while ≥2 indications were reported for 26.1% and 18.4% of pregnancies. The percentage of pregnancies with multiple ultrasounds varied by case status and the presence of ultrasound indications. However, stratified regression models showed no association between increasing ultrasound counts and case status, either for pregnancies without (aOR 1.01, 95% CI 0.92, 1.11) or with ultrasound indications (aOR 1.01, 95% CI 0.95, 1.08). Trimester-specific analyses using medical record data showed no association in any individual trimester.
We found no evidence that prenatal ultrasound use increases ASD risk. Study strengths included gold-standard assessments for ASD case classification, comparison of cases with controls, and a stratified sample to account for conditions associated both with increased prenatal ultrasound use and ASD.
评估产前超声检查与自闭症谱系障碍（ASD）之间关联的研究大多得出了阴性结果。由于自闭症谱系障碍儿童数量的增加和超声检查的应用，人们仍对此表示担忧。
评估产前超声检查与自闭症谱系障碍之间的关联。
我们使用了探索早期发育研究的数据，这是一项在 2007-2012 年期间进行的针对学龄前自闭症谱系障碍儿童的多地点病例对照研究。我们从接受发育障碍服务的儿童中招募病例，并从出生记录中随机选择人群对照。自闭症谱系障碍病例的状态基于面对面的标准化评估。我们按与增加超声使用相关的预先存在的母体医疗条件和妊娠并发症（超声指征）进行分层分析，并使用逻辑回归模型根据超声计数的增加来模拟病例状态。对于有超声检查时间的病历数据的妊娠，我们进行了补充测试，以按暴露的妊娠 trimester 来建立关联模型。
在 1524 例单胎妊娠中，自闭症谱系障碍病例的超声指征比对照组更常见；分别有 45.1%和 54.2%的妊娠没有报告超声指征，而 26.1%和 18.4%的妊娠报告了≥2 个超声指征。具有多次超声检查的妊娠百分比因病例状态和超声指征的存在而有所不同。然而，分层回归模型显示，无论是否存在超声指征，增加超声计数与病例状态之间均无关联（无超声指征的 aOR 为 1.01，95%CI 为 0.92，1.11；有超声指征的 aOR 为 1.01，95%CI 为 0.95，1.08）。使用病历数据进行的 trimester 特异性分析显示，在任何单个 trimester 中均无关联。
我们没有发现产前超声检查会增加自闭症谱系障碍风险的证据。研究的优势包括自闭症谱系障碍病例分类的金标准评估、病例与对照的比较，以及分层样本，以考虑与增加产前超声使用和自闭症谱系障碍均相关的条件。
