The Association between Autism Spectrum Disorder and Pre- and Postnatal Antibiotic Exposure in Childhood-A Systematic Review with Meta-Analysis.

Eunmi Lee,Jeonghyun Cho,Ka Young Kim

doi:10.3390/ijerph16204042

Abstract

Autism spectrum disorder (ASD) is a developmental disorder that begins in early childhood and has been associated with several environmental and genetic factors. We aimed to conduct two-side meta-analyses to determine the association between ASD and pre- and postnatal antibiotic exposure in childhood. We searched PubMed, Embase, Web of Science, and Cochrane Library for articles published up to February 2019. We evaluated observational studies that assessed the association between ASD and antibiotic exposure. Of 1459 articles, nine studies were used in the meta-analysis. We found that early antibiotic exposure, including pre- and postnatal, significantly increased the ASD risk in children. Furthermore, early antibiotic exposure, including pre- and postnatal, was significantly increased in children with ASD. Specifically, prenatal antibiotic exposure was significantly increased in children with ASD; however, postnatal antibiotic exposure was not. Our results indicate an association between ASD and early antibiotic exposure; specifically, that prenatal antibiotic exposure is an important risk factor of ASD in children.

Highlights

Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by communication and interaction difficulties as well as repeated and stereotyped behaviors and interests [1]
For meta-analysis, we included studies that reported the association between ASD and pre- or postnatal antibiotic exposure in childhood and excluded studies that did not report the antibiotic exposure level as well as the ASD and control group
Meta-analysis results showed significantly increased early antibiotic exposure, including pre- and postnatal, in children with ASD (SMD = 0.406, 95% CI: 0.045–0.768, p = 0.028) (Figure 3A)

Summary

Introduction

Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by communication and interaction difficulties as well as repeated and stereotyped behaviors and interests [1]. 66 million individuals worldwide have ASD, and it has been reported to begin early in life [2,3,4]. The exact cause of ASD is unknown, genetic factors are key contributors. Various environmental factors are involved and are considered an important aspect of the increased prevalence of ASD [5,6,7]. Rapid industrialization and the consequent environmental pollution have increased the risk of exposure to toxic substances via various pathways. Since ASD occurs early in life, studies have reported that toxic exposure, such as mercury poisoning in the prenatal or childhood period, could cause ASD [8]. Infant mercury poisoning caused by seafood consumption by the mother, pediatric vaccination, and prenatal use of antibiotics has been suggested to cause

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