A Systematic Review of the Risk Factors for Autism Spectrum Disorder in Children Born Preterm
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A Systematic Review of the Risk Factors for Autism Spectrum Disorder in Children Born Preterm Clodagh Cogley1 · Helen O’Reilly1 · Jessica Bramham1 · Michelle Downes1 Accepted: 21 September 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Preterm birth is associated with an increased risk for autism spectrum disorder, with various factors proposed to underlie this relationship. The aim of this systematic review was to provide a narrative synthesis of the literature regarding the prenatal, perinatal and postnatal factors associated with autism spectrum disorder in children born preterm. Medline, Embase and PsycINFO databases were searched via Ovid to identify studies published from January 1990 to December 2019. Original studies in which a standardized diagnostic tool and/or clinical assessment was used to diagnose autism, along with a risk factor analysis to identify associated predictors, were included. A total of 11 eligible studies were identified. Male sex, being born small for gestational age and general cognitive impairment were the most robust findings, with each reported as a significant factor in at least two studies. Comparisons across studies were limited by variation in risk factor measurement and gestational age ranges investigated. Keywords Autism spectrum disorder · Preterm birth · Risk factors · Systematic review
Introduction Autism spectrum disorder (ASD) is defined by deficits in social communication and interaction as well as restrictive and repetitive behaviors, interests and activities [1]. The prevalence of ASD is higher in children born preterm compared to those born at term [2, 3]; with decreasing gestational age associated with an increased risk of an ASD diagnosis [4–6]. Various risk factors from the prenatal period to later childhood have been investigated in an attempt to understand the relationship between autism and preterm birth [3, 7, 8]. The developmental sociobiological vulnerability model, first proposed by Healy et al. [9], attempts to integrate both the biological and environmental factors that underlie the association between preterm birth and various psychiatric and neurodevelopmental disorders such as autism spectrum disorder [9, 10]. According to this theory, very preterm birth (caused by a combination of genetic factors, obstetric issues and other variables) leads to alterations in typical * Clodagh Cogley [email protected] 1
School of Psychology, University College Dublin, Newman Building, Belfield, Dublin 4, Ireland
neurodevelopment as a result of perinatal brain injury and/ or neonatal pain and stress. This leads to both structural and functional changes in specific brain networks and presents as deficits in cognition and social-emotional functioning. These deficits increase the preterm born child’s socialemotional vulnerability, which may be further mediated by parent stress and mental health. As a result, children born preterm are more vulnerable and at greater risk of negative social experiences, such as bullying
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