Review articleChildhood autism spectrum disorders and exposure to nitrogen dioxide, and particulate matter air pollution: A review and meta-analysis

•We present a review and meta-analysis of studies exploring the link between air pollution and autism spectrum disorders (ASD).•Seven cohorts and five case-control studies undertaken in the US, Taiwan and Europe were included in the meta-analysis.•Exposure to PM2.5 and NO2 during pregnancy is associated with higher risk of ASD, yet it is not statistically significant.•Stronger associations between PM2.5 and NO2 occurred for exposures after birth, yet risk estimates were from only two studies.•While estimates between air pollution and ASD were consistently positive, findings should be interpreted cautiously.

Background and objectiveGenetic and environmental factors have been recognized to play an important role in autism. The possibility that exposure to outdoor air pollution increases the risk of autism spectrum disorder (ASD) has been an emerging area of research. Herein, we present a systematic review, and meta-analysis of published epidemiological studies that have investigated these associations.MethodsWe undertook a comprehensive search strategy to identify studies that investigated outdoor air pollution and autism in children. Overall, seven cohorts and five case-control studies met our inclusion criteria for the meta-analysis. We summarized the associations between exposure to air pollution and ASD based on the following critical exposure windows: (i) first, second and third trimester of pregnancy, (ii) entire pregnancy, and (iii) postnatal period. Random effects meta-analysis modeling was undertaken to derive pooled risk estimates for these exposures across the studies.ResultsThe meta-estimates for the change in ASD associated with a 10 μg/m3 increase in exposure in PM2.5 and 10 ppb increase in NO2 during pregnancy were 1.34 (95% CI:0.83, 2.17) and 1.05 (95% CI:0.99, 1.11), respectively. Stronger associations were observed for exposures received after birth, but these estimates were unstable as they were based on only two studies. O3 exposure was weakly associated with ASD during the third trimester of pregnancy and during the entire pregnancy, however, these estimates were also based on only two studies.ConclusionOur meta-analysis support the hypothesis that exposure to ambient air pollution is associated with an increased risk of autism. Our findings should be interpreted cautiously due to relatively small number of studies, and several studies were unable to control for other key risk factors.