Pre-autism: What a paediatrician should know about early diagnosis of autism‎

Table 1 Factors that increase the risk for autism

Risk	Details
Preconception risks	Presence of another child previously affected with autism
	Increased maternal and paternal age at birth (3.8% increase)
	Birth order: 61% increase in risk in firstborn
	Maternal Obesity or being overweight before pregnancy increases the risk of autism by 36%
Antenatal risk factors for autism[36]	Maternal asthma, allergies
	Preeclampsia
	Maternal bleeding (81% elevated risk)
	Maternal depression or emotional strain. It is believed that stress hormones can cross the placenta-blood barrier and affect the development of fetal brain
	Gestational diabetes (two-fold increased risk of autism)
	Hypothyroidism
	Phthalates (plasticizers) and pesticide exposure: e.g., chlorpyrifos →, sex-hormone pathways disruption → Autism.
	Folate deficiency
	Vitamin D deficiency
	Maternal Infections, e.g., congenital rubella infection, increase the rate of autism to 1:13
	Hospitalization due to antenatal infection increases the risk of autism by 30%
	Abnormal fetal growth could indicate disrupted fetal brain development. Being small or large for gestational age increases the risk of autism
	Prenatal Hormone Levels: Higher levels of prenatal testosterone may be related to an increased risk of autism
Postnatal risk factors for autism	Urbanization of birthplace
	Prematurity by more than 9 wks → higher odds of autism
	Birth injuries to the cerebellum increase the risk of autism by 3.8-fold
	Neonatal seizure
Potential risk factors for autism in neonates requiring NICU	Family history of neuropsychiatric disorders
	Maternal psychological distress during pregnancy
	Duration of stay ≥ 26 d in the NICU
	Tube feeding tube for ≥ 15 d
	Retinopathy of prematurity
	The need to use three or more antibiotics
	Co-sleeping until two years of age

NICU: Neonatal Intensive Care Unit.