Is air pollution a plausible candidate for prenatal exposure in autism spectrum disorder (ASD)? : a systematic review / y Dhanashree Vernekar

Abstract

Objective: To present a systematic review of existing literature that investigates biological plausibility of prenatal hazardous air pollutants’ (HAPs) exposure, in the etiology of autism spectrum disorder (ASD) and related outcomes. Method: Electronic databases Pubmed, Biomed Central and National Database for Autism Research, and grey literature pertaining to air pollution association with ASD and related outcomes were searched using specific keywords. The search included 190 HAPs as defined by The Clean Air Act Amendments of 1990 [U.S.Environmental Protection Agency (EPA) 1994] including air pollutants CO, SO2, NOx, O3 and Particulate Matter (PM). Studies selected for systematic review were assessed on quality and causality. Result: Total of 628 articles from electronic search and 16 articles from grey literature were retrieved. 12 studies that cleared the inclusion and exclusion criteria were systematically reviewed using the PRISMA checklist. Outcomes considered included ASD, Attention Deficit Hyperactivity Disorder, social behavior, social interaction, child behavior, communication, cognitive development, attention problems, mental and psychomotor development, and social competence. Studies were from two countries, United States of America and Spain. Study design was case control and cohort study. Follow up duration for cases ranged from in-utero to less than 9 years. Exposure was measured in ambient air using predictive models and cord blood. Although there were discrepancies in the studies, related to strength of association, analysis and covariates adjusted, the association between air pollution and ASD related outcomes could not be dismissed. Most studies lacked information on blinding when quality was assessed and lacked consistency when assessed on causality, while scored well on temporality and biological plausibility. Discussion: Evidence suggests HAPs are capable of transplacentally affecting cognitive function, especially traffic related pollutants. Study design, sample size, response rate, exposure misclassification, failing to adjusting covariates related to lifestyle, nutrition and other chemical exposures have influenced the estimates and the strength of association. Shortcomings of this review are the English language restriction and single reviewer on study selection process and assessments. Immuno-toxic, neuro-toxic and endocrine disrupting properties of these HAPs necessitates comprehensive prospective studies especially in Hong Kong with the rising prevalence of ASD and ever high reported air pollution indexes. Conclusion: Repeated studies were carried out on the same cohorts and studies were concentrated in U.S.A. On account of a lack of consistency, it is difficult to confirm whether air pollution is a plausible candidate for prenatal exposure in ASD. (Abstract of 391 words)