Transtorno do espectro autista e fatores pré-natais: um estudo de caso controle no Brasil

Abstract

Autism Spectrum Disorder (ASD) is a disorder in neurodevelopment, marked by a lacking pattern in social communication and atypical sensory-motor behaviors, generally marked by repetition, possible to reach a heterogeneous group of people. Its etiology is multifactorial involving genetic and environmental factors. Current treatment includes pharmacological measures, aiming to lessen aggressive behaviors or to reduce psychiatric comorbidities; and non-pharmacological, aiming to facilitate social interactions of the subject. This study had as an objective to investigate the association between autism spectrum disorder (ASD) and prenatal factors in a population of the North of Minas Gerais, Brazil. For this purpose, data from a case-control study that assessed pre, peri and postnatal factors associated with ASD conducted with the responsible people for 248 children/adolescents diagnosed with ASD (case group) and 886 neurotypical (control group) were used. The following variables related to prenatal were analyzed: location of prenatal; pregnancy acceptance; stress episode; depression, sadness or anxiety episode; incidence of pre-eclampsia or eclampsia; presence of bleeding; presence of infection; presence of fever; use of ferrous sulphate and use of medication. In addition to this, the following group of variables were analyzed with the goal to control possible confounding factors: characteristics of the child (gender, age and very low weight when born), characteristics of the mother (age in giving birth and self-declared skin color). Family history (ASD history in 1º degree relatives). A semi-structured questionnaire was used to collect data and a logistic regression model was adopted to estimate the crude and adjusted odds ratio (OR). In the adjusted model, a positive and significant association with ASD was identified with the following prenatal factors: prenatal done in private care (OR=1,59; CI 95%:1,13-2,23); Presence of depression, sadness or anxiety during pregnancy (OR=2,10; CI 95% 1,51-2,92); Incidence of pre-eclampsia or eclampsia (OR=1,61; CI 95% 0,93-2,77); Presence of bleeding in pregnancy (OR=1,54; CI 95% 1,03-2,30); Absence of ferrous sulphate/iron supplement in pregnancy (OR=1,52; CI 95%:1,00-2,30), after adjustment for the variables: gender of the child, weight in birth, age of mother when giving birth, mother’s skin color and ASD family history. The results found can be useful for prenatal advice on modifiable risk factors and early diagnosis, constituting as potential help in the planning of public health policies.