Salehi Amir Mohammad, Ayubi Erfan, Khazaei Salman, Jenabi Ensiyeh, Bashirian Saeid, Salimi Zohreh
Student Research Committee, Hamadan University of Medical Sciences School of Medicine, Hamadan, Iran.
Social Determinants of Health Research Center, Hamadan University of Medical Sciences, Hamadan, Iran.
Clin Exp Pediatr. 2024 Sep;67(9):459-464. doi: 10.3345/cep.2024.00136. Epub 2024 Jul 19.
Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by severe social communication deficits and stereotypical repetitive behaviors.
This umbrella review assessed neonatal risk factors associated with ASD using meta-analyses and systematic reviews.
We conducted a systematic search of interna- tional databases including PubMed, Scopus, and Web of Science for studies published through April 2022 utilizing pertinent keywords. A random-effects model was used to calculate the odds ratio (OR) and 95% confidence interval (CI). Substantial heterogeneity was considered at values of I2≥50%. A quality assessment of the included studies was performed using the A MeaSurement Tool to Assess Systematic Reviews (AMSTAR2) checklist.
A total of 207,221 children with ASD and 22,993,128 neurotypical children were included. Six meta- analyses were included in this umbrella review. The factors of congenital heart disease (OR, 1.35; 95% CI, 1.17-1.52), macrosomia (OR, 1.11; 95% CI, 1.05-1.18), low birth weight (OR, 1.63; 95% CI, 1.48-1.81), very low birth weight (OR, 2.25; 95% CI, 1.79-2.83), small for gestational age (OR, 1.17; 95% CI, 1.09-1.24), jaundice (OR, 1.74; 95% CI, 1.42- 2.12), male sex (OR, 1.47; 95% CI, 1.39-1.55) and 1-minute Apgar score <7 (OR, 1.40; 95% CI, 1.26-1.55) were graded as suggestive evidence (class III). Only 3 studies reported heterogeneity (I2<50%). Based on the AMSTAR2 analysis, the methodological quality was critically low in 3 meta- analyses, low in 2, and moderate in 1.
Based on these results, clinicians should consider the risk factors for ASD and screen children in clinics.
自闭症谱系障碍（ASD）是一种神经发育障碍，其特征为严重的社交沟通缺陷和刻板重复行为。
本综述通过荟萃分析和系统评价评估与ASD相关的新生儿危险因素。
我们利用相关关键词对包括PubMed、Scopus和Web of Science在内的国际数据库进行了系统检索，以查找截至2022年4月发表的研究。采用随机效应模型计算比值比（OR）和95%置信区间（CI）。当I2≥50%时，认为存在显著异质性。使用评估系统评价的测量工具（AMSTAR2）清单对纳入研究进行质量评估。
共纳入207,221例ASD儿童和22,993,128例神经发育正常儿童。本综述纳入了六项荟萃分析。先天性心脏病（OR，1.35；95%CI，1.17 - 1.52）、巨大儿（OR，1.11；95%CI，1.05 - 1.18）、低出生体重（OR，1.63；95%CI，1.48 - 1.81）、极低出生体重（OR，2.25；95%CI，1.79 - 2.83）、小于胎龄儿（OR，1.17；95%CI，1.09 - 1.24）、黄疸（OR，1.74；95%CI，1.42 - 2.12）、男性（OR，1.47；95%CI，1.39 - 1.55）和1分钟阿氏评分<7（OR，1.40；95%CI，1.26 - 1.55）等因素被列为提示性证据（III类）。只有3项研究报告了异质性（I2<50%）。基于AMSTAR2分析，3项荟萃分析的方法学质量极低，2项较低，1项中等。
基于这些结果，临床医生应考虑ASD的危险因素并在诊所对儿童进行筛查。
