“…20 found a negative association (OR = 0.7, 95% CI: 0.5–1.0). Similarly, positive 21, 22 , negative 23, 24 , and null 25–28 associations have been observed in United States study populations. Three meta-analyses have also been conducted, each finding no evidence for a significant association between maternal smoking and ASD risk in offspring.…”
Section: Introductionmentioning
confidence: 60%
“…Four articles 33–36 were then excluded for lacking sufficient data to fill the contingency table of binary maternal smoking and ASD variables. Consequently, 22 articles 17–28, 32, 37–45 were included for meta-analysis.Figure 1Study selection strategy.
…”
Section: Resultsmentioning
confidence: 99%
“…The 22 studies analyzed include seven cohort studies 19, 23, 39, 40, 43–45 and fifteen case-control studies 17, 18, 20–22, 24–28, 32, 37, 38, 41, 42 , with a total of 795,632 cases and 1,829,256 control participants. Nine studies 17–20, 37, 38, 41, 42, 45 were from Europe (Denmark, Sweden, Finland, The Netherlands, and Poland), twelve studies 21–28, 39, 40, 43, 44 were from North America (Canada and U.S.) and one study 32 was from Asia (China).…”
Section: Resultsmentioning
confidence: 99%
“…Nine studies 17–20, 37, 38, 41, 42, 45 were from Europe (Denmark, Sweden, Finland, The Netherlands, and Poland), twelve studies 21–28, 39, 40, 43, 44 were from North America (Canada and U.S.) and one study 32 was from Asia (China). Information on smoking during pregnancy was collected during a prenatal visit or at birth in 11/22 studies, and ASD diagnosis was ascertained by medical records in 16/22 studies (Supplementary Table S1).…”
Section: Resultsmentioning
confidence: 99%
“…Overall, the studies had moderate methodological quality as scored on a conservatively-interpreted NOS, with an average score of 6.5 and a range of 4–9. Based on thirds of the range of scores, four studies were considered “high” quality with NOS scores of 8 or 9 17, 22, 25, 37 , ten studies were considered “medium” quality with NOS scores of 6 or 7 18, 21, 23, 26, 38–40, 42, 44, 45 , and eight studies were considered “low” quality with NOS scores of 4 to 5.5 19, 20, 24, 27, 28, 32, 41, 43 (Supplementary Tables S1 and S2). Figure 2Distribution of studies used in the meta-analysis by ( a ) study quality, as assessed on the NOS by two independent raters with high correlation ( r (20) = 0.81, p < 0.00001), and by ( b ) funnel plot, to diagnose publication bias.
…”
While exposure to nicotine during developmental periods can significantly affect brain development, studies examining the association between maternal smoking and autism spectrum disorder (ASD) in offspring have produced conflicting findings, and prior meta-analyses have found no significant association. Our meta-analysis used a novel approach of investigating population-level smoking metrics as moderators. The main meta-analysis, with 22 observational studies comprising 795,632 cases and 1,829,256 control participants, used a random-effects model to find no significant association between maternal smoking during pregnancy and ASD in offspring (pooled odds ratio (OR) = 1.16, 95% CI: 0.97–1.40). However, meta-regression analyses with moderators were significant when we matched pooled ORs with adult male smoking prevalence (z = 2.55, p = 0.01) in each country, using World Health Organization data. Our study shows that using population-level smoking metrics uncovers significant relationships between maternal smoking and ASD risk. Correlational analyses show that male smoking prevalence approximates secondhand smoke exposure. While we cannot exclude the possibility that our findings reflect the role of paternal or postnatal nicotine exposure, as opposed to maternal or in utero nicotine exposure, this study underlines the importance of investigating paternal and secondhand smoking in addition to maternal smoking in ASD.
“…20 found a negative association (OR = 0.7, 95% CI: 0.5–1.0). Similarly, positive 21, 22 , negative 23, 24 , and null 25–28 associations have been observed in United States study populations. Three meta-analyses have also been conducted, each finding no evidence for a significant association between maternal smoking and ASD risk in offspring.…”
Section: Introductionmentioning
confidence: 60%
“…Four articles 33–36 were then excluded for lacking sufficient data to fill the contingency table of binary maternal smoking and ASD variables. Consequently, 22 articles 17–28, 32, 37–45 were included for meta-analysis.Figure 1Study selection strategy.
…”
Section: Resultsmentioning
confidence: 99%
“…The 22 studies analyzed include seven cohort studies 19, 23, 39, 40, 43–45 and fifteen case-control studies 17, 18, 20–22, 24–28, 32, 37, 38, 41, 42 , with a total of 795,632 cases and 1,829,256 control participants. Nine studies 17–20, 37, 38, 41, 42, 45 were from Europe (Denmark, Sweden, Finland, The Netherlands, and Poland), twelve studies 21–28, 39, 40, 43, 44 were from North America (Canada and U.S.) and one study 32 was from Asia (China).…”
Section: Resultsmentioning
confidence: 99%
“…Nine studies 17–20, 37, 38, 41, 42, 45 were from Europe (Denmark, Sweden, Finland, The Netherlands, and Poland), twelve studies 21–28, 39, 40, 43, 44 were from North America (Canada and U.S.) and one study 32 was from Asia (China). Information on smoking during pregnancy was collected during a prenatal visit or at birth in 11/22 studies, and ASD diagnosis was ascertained by medical records in 16/22 studies (Supplementary Table S1).…”
Section: Resultsmentioning
confidence: 99%
“…Overall, the studies had moderate methodological quality as scored on a conservatively-interpreted NOS, with an average score of 6.5 and a range of 4–9. Based on thirds of the range of scores, four studies were considered “high” quality with NOS scores of 8 or 9 17, 22, 25, 37 , ten studies were considered “medium” quality with NOS scores of 6 or 7 18, 21, 23, 26, 38–40, 42, 44, 45 , and eight studies were considered “low” quality with NOS scores of 4 to 5.5 19, 20, 24, 27, 28, 32, 41, 43 (Supplementary Tables S1 and S2). Figure 2Distribution of studies used in the meta-analysis by ( a ) study quality, as assessed on the NOS by two independent raters with high correlation ( r (20) = 0.81, p < 0.00001), and by ( b ) funnel plot, to diagnose publication bias.
…”
While exposure to nicotine during developmental periods can significantly affect brain development, studies examining the association between maternal smoking and autism spectrum disorder (ASD) in offspring have produced conflicting findings, and prior meta-analyses have found no significant association. Our meta-analysis used a novel approach of investigating population-level smoking metrics as moderators. The main meta-analysis, with 22 observational studies comprising 795,632 cases and 1,829,256 control participants, used a random-effects model to find no significant association between maternal smoking during pregnancy and ASD in offspring (pooled odds ratio (OR) = 1.16, 95% CI: 0.97–1.40). However, meta-regression analyses with moderators were significant when we matched pooled ORs with adult male smoking prevalence (z = 2.55, p = 0.01) in each country, using World Health Organization data. Our study shows that using population-level smoking metrics uncovers significant relationships between maternal smoking and ASD risk. Correlational analyses show that male smoking prevalence approximates secondhand smoke exposure. While we cannot exclude the possibility that our findings reflect the role of paternal or postnatal nicotine exposure, as opposed to maternal or in utero nicotine exposure, this study underlines the importance of investigating paternal and secondhand smoking in addition to maternal smoking in ASD.
Evidence is accumulating for potential contributions to ASD risk from preconception or prenatal maternal nutrition, lifestyle, infection, medications, and exposures to environmental chemicals. No single or universal cause is likely; rather, multiple genetic variants and noninherited factors appear to combine to affect each child's development. Key concepts for future research include specificity to ASD versus causes common to other neurodevelopmental conditions, gene‐by‐environment interactions, and critical windows of vulnerability that may vary by exposure.
Professionals, celebrities, and media frequently suggest to parents the possible treatment options for their children with autism. Some treatment recommendations advocate for scientifically supported treatments whereas others suggest novel, untested interventions, or potentially ineffective or harmful treatments. The current study examined the print media's coverage of applied behavior analysis (ABA) and nonscientifically supported autism treatments. Over the last 10 years, print media have increasingly published articles referring to autism treatments with little scientific support and a decreased coverage of ABA. Print media's positive statements about non-scientifically supported treatments also increased over the last decade, whereas positive statements about ABA decreased. ABA received two times as many positive comments as negative; however, non-scientifically supported treatments as a group received four times as many positive comments as negative. These results could contribute to parents' decisions to implement treatments for their children with autism. To contribute to future positive perception of ABA, we provided suggestions for the dissemination of information to increase positive reporting of ABA in print media.Once autism treatments were selected and classified, keywords related to each treatment to be used for database searches of representative newspaper and magazine articles were determined. Several references providing comprehensive and detailed treatment descriptions were used (Freeman, 2007;Jacobson et al., 2005; New York State Department of Health, Early Intervention Program, 1999;Richdale & Schreck, 2008;Romanczyk et al., 2008) to obtain synonyms or abbreviations (e.g., sensory integration training = SIT and auditory integration training = AIT), methodological descriptions (e.g., SIT = swinging and applied behavior analysis = ABA), and treatment instruments (e.g., SIT = scooter and facilitated communication = letter board) for keyword selection. To be included as a keyword, each of the synonyms, methodological descriptions, or treatment instruments must have been associated with the treatments in ≥2 of the reference sources. Words that contained roots of the keywords were included (e.g., chelator and chelating were counted as chelation). Words were excluded if they were listed in only one source. Although early intensive behavioral intervention (EIBI) was not mentioned in ≥2 of the reference sources, EIBI was included as a search term to provide a possible mechanism for increasing the possible print media coverage of ABA. No additional articles or keyword mentions were found for EIBI. Consequently, the scientifically supported keywords were limited to the keywords and synonyms listed in ≥2 of the previously mentioned references. Table 1 includes a complete list of the keywords for each autism treatment.
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