441 - Associations Between Preterm Birth and Autism Spectrum Disorder: A Systematic Review and Meta-Analysis

Poster Number: 441
Publication Number: 441.121

Olivia Bayliss, Mothers, Babies and Women’s Health Program, Mater Research Institute, Faculty of Medicine, The University of Queensland., Indooroopilly, Queensland, Australia; Jessica Lee, Mothers, Babies and Women’s Health Program, Mater Research Institute, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia; Jemima K. Walker, Mothers, Babies and Women's Health Program, Mater Research Institute, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia; Carmina Erdei, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States; Hudson (Gerry) Taylor, Nationwide Children's Hospital, Columbus, OH, United States; Samudragupta Bora, Mater Research Institute, Faculty of Medicine, The University of Queensland, South Brisbane, Queensland, Australia

Background: Children born preterm are at an elevated risk of Autism Spectrum Disorder (ASD). However, studies documenting associations between preterm birth and ASD have reported disparate findings primarily due to variations in study design, clinical and sociodemographic characteristics, and assessment tools.

Objective: To meta-analyze studies reporting ASD diagnosis and positive screening of symptomatology in children born preterm, compared with children born full-term, across the spectrum of prematurity and assessment age.

Design/Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA, 2020) guideline was followed. Two reviewers independently screened three electronic databases (PubMed/MEDLINE, PsycINFO, CINAHL) using combinations of MeSH terms and keywords, along with relevant reference lists. Peer reviewed publications in English between 1994 and 2021 were included if: 1) the sample consisted of preterm-born and full-term children aged between 2 and 21 years, 2) reporting a clinical diagnosis of ASD, or recognition of ASD symptomology using screening tools according to DSM-IV or 5 criteria, using 3) cohort study designs. The methodological quality of studies and risk of bias were assessed using the Newcastle-Ottawa Scale. Pooled estimates were determined using random-effects models.

Results: The systematic review yielded 11,287 studies, of which 17 fulfilled the inclusion criteria. The pooled sample size included 2,880 children born preterm and 4,472 children born full-term, ensuring sample independence. As shown in Figure 1 and 2, children born preterm were at significantly higher risk of ASD diagnosis (OR 4.00, 95% CI=1.87—8.55) and positive screening of symptomatology (OR 2.90, 95% CI=1.82—4.62), ­respectively, relative to children born full-term. As shown in Figure 3, significant linear associations were evident for ASD risk and gestational and assessment ages. ­Conclusion(s): Findings provide robust evidence that preterm birth is associated with an increased risk of ASD compared with full-term peers, with indications of higher risk for those born extremely preterm as well as those assessed during adolescent years. Future research needs to prioritize better identification of biological and social factors underlying the associations between preterm birth and risk of ASD which will inform early detection and intervention.
Figure 1 - Random-Effects Forest Plot of Risk of ASD Diagnosis for Preterm and Full-Term Children
Figure 2 - Random-Effects Forest Plot of Risk of Positive Screening of ASD Symptomatology for Preterm and Full-Term Children