Vol.:(0123456789) 1 3 Journal of Autism and Developmental Disorders https://doi.org/10.1007/s10803-017-3449-x ORIGINAL PAPER Association of Autism with Maternal Infections, Perinatal and Other Risk Factors: A Case-Control Study Dikran Richard Guisso 1  · Fadi S. Saadeh 1  · Dahlia Saab 2  · Joud El Deek 1  · Sarah Chamseddine 1  · Hadi Abou El Hassan 1  · Ghidaa Majari 1  · Rose‑Mary Boustany 2,3 © Springer Science+Business Media, LLC, part of Springer Nature 2018 Abstract This case-control study explores the association between pregnancy/birth complications and other factors with Autism Spec- trum Disorder (ASD) in Lebanese subjects aged 2–18 years. Researchers interviewed 136 ASD cases from the American University of Beirut Medical Center Special Kids Clinic, and 178 controls selected by systematic digit dialing in the Greater- Beirut area. Male gender (Adjusted Odds Ratio [95% CI]: 3.9 [2.2–7.0]); postpartum feeding difculties (2.5 [1.2–5.4]); maternal infections/complications during pregnancy (2.9 [1.5–5.5], 2.1 [1.1–3.9]); consanguinity (2.5 [1.0–6.0]); family history of psychiatric disorders (2.2 [1.1–4.4]) were risk factors for ASD. Being born frst/second (0.52 [0.28–0.95]) and maternal psychological support during pregnancy (0.49 [0.27–0.89]) were negatively associated with ASD. Identifying ASD correlates is crucial for instigating timely screening and subsequent early intervention. Keywords Autism · Risk factors · Maternal infections · Perinatal factors · Consanguinity Introduction Autism spectrum disorder (ASD) is a constellation of devel- opmental disorders characterized by diminished social inter- actions, restrictive behaviors and stereotypies, reduced eye contact and delayed acquisition of speech (Christensen et al. 2016). The prevalence of this disorder has risen with num- bers reaching 1 in 68 children in 2010 in the United States (Christensen et al. 2016). In 2014, ASD was associated with $3020 higher health care costs and $14,061 higher aggregate non-health care costs than those for typically developing children in the United States (Lavelle et al. 2014). The etiology of ASD is diverse and there is a wide variety of genetic and environmental factors associated with this disorder (Chaste and Leboyer 2012). Newschafer, Fallin and Lee (2002) segregated risk factors into genetic predisposi- tion of the mother and the child and environmental factors afecting the mother and the child. Moreover, the number of research looking at gene versus environment interactions has risen (Kim and Leventhal 2015; Tordjman et al. 2014). Focusing on fnding environmental factors associated with autism and exploring interactions between the genetic and environmental components for the development of autism are, therefore, needed (Chaste and Leboyer 2012). Many major environmental risk factors are implicated as associated with the development of ASD, including prenatal and perinatal factors, socio-economic status and drugs and toxic exposure (Chaste and Leboyer 2012). Among prenatal and perinatal factors, ASD may be associated with mater- nal infections (Mazina et al. 2015) with one study reporting a 30% increased risk of ASD with inpatient diagnosis of maternal infection (Lee et al. 2015). A study from Denmark identifed a more specifc correlation between frst trimes- ter viral infections and second trimester bacterial infections Dikran Richard Guisso, Fadi S. Saadeh, and Dahlia Saab have comtributed equllly to this work. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10803-017-3449-x) contains supplementary material, which is available to authorized users. * Rose-Mary Boustany rb50@aub.edu.lb 1 Faculty of Medicine, American University of Beirut, Beirut, Lebanon 2 Department of Biochemistry and Molecular Genetics, American University of Beirut, Riad El Solh, P. O. Box 11-0236, Beirut 1107 2020, Lebanon 3 Department of Pediatrics and Adolescent Medicine, American University of Beirut, Beirut, Lebanon