School of Medicine, Postgraduate Program in Medicine and Health Sciences, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil.
Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.
BMC Public Health. 2024 Sep 3;24(1):2388. doi: 10.1186/s12889-024-19742-w.
Autism Spectrum Disorder (ASD) is a lifelong neurodevelopmental condition affecting communication, social interaction, and behavior. Evidence suggests that environmental pollutants are associated with ASD incidence. This review aimed to analyze the effect of environmental pollutants on ASD.
Systematic review and meta-analysis of cohort studies evaluated the association between exposure to environmental pollutants and ASD. We searched COCHRANE CENTRAL, MEDLINE, CINAHL, LILACS, EMBASE, PsycINFO, Web of Science, SciELO, and gray literature from inception to January 2023. The model used for meta-analysis was inverse variance heterogeneity (IVhet). The effect measures were the beta coefficient (β) and the relative risk (RR) with their 95% confidence intervals (95% CI). Sensitivity analyses were carried out using an instrument to screen or diagnose autism.
A total of 5,780 studies were identified; 27 were included in the systematic review, and 22 were included in the meta-analysis. These studies included 1,289,183 participants and 129 environmental pollutants. Individual meta-analyses found a significant association between nitrogen dioxide RR = 1.20 (95% CI: 1.03 to 1.38; I: 91%), copper RR = 1.08 (95% CI: 1.03 to 1.13; I: 0%), mono-3-carboxy propyl phthalate β = 0.45 (95% CI: 0.20 to 0.70; I: 0%), monobutyl phthalate β = 0.43 (95% CI: 0.13 to 0.73; I: 0%) and polychlorinated biphenyl (PCB) 138 RR = 1.84 (95% CI: 1.14 to 2.96; I:0%) with ASD. Subgroup meta-analyses found a significant association with carbon monoxide RR = 1.57 (95% CI: 1.25 to 1.97; I: 0%), nitrogen oxides RR = 1.09 (95% CI: 1.04 to 1.15; I: 34%) and metals RR = 1.13 (95% CI: 1.01 to 1.27; I:24%).
This study found positive associations nitrogen dioxide, copper, mono-3-carboxypropyl phthalate, monobutyl phthalate, and PCB 138, and the development of ASD, likewise, with subgroups of pollutants carbon monoxide, nitrogen oxides, and metals. Therefore, it is important to identify these risk factors in children and adolescents to contribute to ASD and identify prevention strategies effectively.
自闭症谱系障碍（ASD）是一种影响沟通、社交互动和行为的终身神经发育障碍。有证据表明，环境污染物与 ASD 的发病率有关。本研究旨在分析环境污染物对 ASD 的影响。
对队列研究进行系统评价和荟萃分析，评估暴露于环境污染物与 ASD 之间的关系。我们从建库开始至 2023 年 1 月，在 Cochrane 中心、MEDLINE、CINAHL、LILACS、EMBASE、PsycINFO、Web of Science、SciELO 和灰色文献中进行了检索。荟萃分析中使用的模型是Inverse Variance Heterogeneity（IVhet）。效应量为β系数（β）和相对风险（RR）及其 95%置信区间（95%CI）。使用自闭症筛查或诊断工具进行了敏感性分析。
共确定了 5780 项研究；其中 27 项被纳入系统评价，22 项被纳入荟萃分析。这些研究共纳入了 1289183 名参与者和 129 种环境污染物。个体荟萃分析发现，二氧化氮 RR=1.20（95%CI：1.03 至 1.38；I：91%）、铜 RR=1.08（95%CI：1.03 至 1.13；I：0%）、邻苯二甲酸单-3-羧丙酯β=0.45（95%CI：0.20 至 0.70；I：0%）、邻苯二甲酸单丁酯β=0.43（95%CI：0.13 至 0.73；I：0%）和多氯联苯（PCB）138 RR=1.84（95%CI：1.14 至 2.96；I：0%）与 ASD 呈显著相关。亚组荟萃分析发现，一氧化碳 RR=1.57（95%CI：1.25 至 1.97；I：0%）、氮氧化物 RR=1.09（95%CI：1.04 至 1.15；I：34%）和金属 RR=1.13（95%CI：1.01 至 1.27；I：24%）与 ASD 也呈显著相关。
本研究发现，二氧化氮、铜、邻苯二甲酸单-3-羧丙酯、邻苯二甲酸单丁酯和 PCB 138 以及一氧化碳、氮氧化物和金属等亚组与 ASD 的发展呈正相关。因此，识别儿童和青少年的这些危险因素对于有效识别 ASD 并确定预防策略非常重要。
