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Pre-conceptional and prenatal exposure to secondhand smoke and autism spectrum disorder: a national multi-center study in China

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Abstract

Background

Despite extensive research evaluating the association between prenatal exposure to secondhand smoke (SHS) and the development of autism spectrum disorders (ASD), no study has investigated the association by considering the pre-conceptional period. This study aimed to investigate the associations of pre-conceptional and prenatal SHS exposure and the development of ASD among toddlers.

Methods

In this cross-sectional study, parents of 6049 toddlers aged 16–30 months were recruited from 7 tertiary hospitals, 21 communities, and 7 kindergartens located in seven cities in six provinces from five geographical regions of China. We analyzed the associations of SHS exposure and the odds of ASD among toddlers in different exposure windows (pre-conceptional and/or prenatal periods). Data were analyzed from November 2021 to January 2022.

Results

Among the 6049 toddlers included in the analysis [22.7 (4.1) months; 44.8% girls], 71 were identified and diagnosed with ASD. Compared with the unexposed toddlers, toddlers with pre-conceptional SHS exposure had higher odds of ASD (OR 2.30, 95% CI 1.36–3.84), while we observed a non-significantly positive association regarding prenatal SHS exposure. When considering both pre-conceptional and prenatal periods, toddlers who were continuously exposed to SHS during these two periods had higher odds than those without SHS exposure (OR 2.32, 95% CI 1.24–4.14).

Conclusion

We reported positive SHS–ASD associations when exposed during the pre-conceptional period and continuously exposed during pre-conceptional and prenatal periods, emphasizing the critical window of pre-conception for targeted intervention on smoking.

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Data availability statement

Data will be made available on reasonable request from corresponding authors by email.

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Acknowledgements

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Funding

This work was supported by the Key-Area Research and Development Program of Guangdong Province, China (2019B030335001), the National Natural Science Foundation of China, China (82103794), and the National Social Science Foundation of China (20&ZD296).

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    Authors and Affiliations

    1. Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-Sen University, 74 Zhongshan 2nd Road, Yuexiu District, Guangzhou, 510080, China

      Li-Zi Lin & Guang-Hui Dong

    2. Department of Maternal and Child Health, School of Public Health, Sun Yat-Sen University, 74 Zhongshan 2Nd Road, Yuexiu District, Guangzhou, 510080, China

      Xiao-Xuan Ou, Xiao-Ling Zhan, Xin Wang, Li Cai, Xiu-Hong Li & Jin Jing

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    1. Li-Zi Lin
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    Contributions

    LLZ: conceptualization, supervision, project administration, funding acquisition, methodology, formal analysis, software, validation, resources, investigation, data curation, writing–original draft, writing–review and editing. OXX: methodology, formal analysis, software, validation, resources, investigation, data curation, writing—original draft, writing—review and editing. ZXL: investigation, writing–review and editing. WX: software, validation, resources, investigation, writing–review and editing. CL, LXH: writing–review and editing. DGH, JJ: conceptualization, supervision, project administration, funding acquisition, writing–review and editing. LLZ and OXX contributed equally to this work and should be listed as the first author.

    Corresponding authors

    Correspondence to Jin Jing or Guang-Hui Dong.

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    No financial or non-financial benefits have been received or will be received from any party related directly or indirectly to the subject of this article. None of any authors serves as a current Editorial Team member (such as Chief Editors, Deputy Chief Editors, Associate Editors, Editorial Board Member) for this journal.

    Ethical approval

    This study was approved by the Ethical Review Committee for Biomedical Research, Sun Yat-sen University. Informed consent to participate in the study has been obtained from participants (or their parent or legal guardian in the case of children under 16).

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    Lin, LZ., Ou, XX., Zhan, XL. et al. Pre-conceptional and prenatal exposure to secondhand smoke and autism spectrum disorder: a national multi-center study in China. World J Pediatr 19, 761–769 (2023). https://doi.org/10.1007/s12519-022-00644-z

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