Evidence map›Paper›PMID 31230684›Full record

SynthesisThe lancet. Psychiatry2019

Environmental risk factors and biomarkers for autism spectrum disorder: an umbrella review of the evidence.

Jong Yeob Kim, Min Ji Son, Chei Yun Son, Joaquim Radua, Michael Eisenhut, Florence Gressier, Ai Koyanagi, Andre F Carvalho, Brendon Stubbs, Marco Solmi and 6 more

Open access · greenAbstract readSystematic Review
PubMed Publisher
In one paragraph

Synthesis in The lancet. Psychiatry, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 139 papers, 30 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
139citing papers in PubMed, 30 pooled it
20.5field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

139 citing papers in PubMed, 30 syntheses or guidelines pooled it, 262 citations in OpenAlex.

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  19. Non-genetic biomarkers for ankylosing spondylitis: An umbrella review.Journal of clinical laboratory analysis · 2022
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79 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

16 authors at 14 institutions in 9 countries.

Jong Yeob KimYonsei University College of Medicine, Seoul, Republic of Korea.
Min Ji SonYonsei University College of Medicine, Seoul, Republic of Korea.
Chei Yun SonDepartment of Psychological & Brain Sciences, Washington University in St. Louis, MO, USA.
Joaquim RaduaEarly Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; FIDMAG Germanes Hospitalaries, CIBERSAM, Barcelona, Spain; Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
Michael EisenhutDepartment of Pediatrics, Luton & Dunstable University Hospital NHS Foundation Trust, Luton, UK.
Florence GressierCESP, Inserm UMR1178, Department of Psychiatry, Assistance Publique-Hôpitaux de Paris, Bicêtre University Hospital, Le Kremlin Bicêtre, France.
Ai KoyanagiResearch and Development Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Déu, Barcelona, Spain; Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain; Centre for Addiction & Mental Health, Toronto, ON, Canada.
Andre F CarvalhoCentre for Addiction & Mental Health, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
Brendon StubbsPhysiotherapy Department, South London and Maudsley NHS Foundation Trust, London, UK; Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
Marco SolmiDepartment of Neurosciences and Neurosciences Center, University of Padua, Padua, Italy; Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
Theodor B RaisDepartment of Psychiatry, University of Toledo Medical Center, Toledo, Ohio, USA.
Keum Hwa LeeDepartment of Pediatrics, Yonsei University College of Medicine, Seoul, South Korea; Department of Pediatrics, Severance Children's Hospital, Seoul, South Korea.
Andreas KronbichlerDepartment of Internal Medicine IV, Medical University Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria.
Elena DragiotiPain and Rehabilitation center and Department of Medicine and Health Sciences (IMH), Faculty of Health Sciences University of Linköping, Linköping, Sweden.
Jae Il ShinDepartment of Pediatrics, Yonsei University College of Medicine, Seoul, South Korea; Department of Pediatrics, Severance Children's Hospital, Seoul, South Korea. Electronic address: shinji@yuhs.ac.
Paolo Fusar-PoliEarly Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; OASIS Service, South London and Maudsley NHS Foundation Trust, London, UK. Electronic address: paolo.fusar-poli@kcl.ac.uk.
Yonsei University · KRCentre de recherche en Epidémiologie et Santé des Populations · FRCentre for Addiction and Mental Health · CAConsorci Institut D'Investigacions Biomediques August Pi I Sunyer · ESInnsbruck Medical University · ATKing's College London · GBLinköping University · SELuton and Dunstable University Hospital NHS Foundation Trust · GBParc Sanitari Sant Joan de Déu · ESSeverance Hospital · KRSouth London and Maudsley NHS Foundation Trust · GBUniversity of Padua · ITUniversity of Toledo Medical Center · USWashington University in St. Louis · US

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundNumerous studies have identified potential risk factors and biomarkers for autism spectrum disorder. We aimed to study the strength and validity of the suggested environmental risk factors or biomarkers of autism spectrum disorder.

methodsWe did an umbrella review and systematically appraised the relevant meta-analyses of observational studies. We searched PubMed, Embase, and the Cochrane Database of Systematic Reviews for papers published between database inception and Oct 17, 2018, and screened the reference list of relevant articles. We obtained the summary effect, 95% CI, heterogeneity, and 95% prediction intervals. We examined small study effects and excess significance. We did analyses under credibility ceilings. This review is registered with PROSPERO, number CRD42018091704.

findings46 eligible articles yielded data on 67 environmental risk factors (544 212 cases, 81 708 787 individuals) and 52 biomarkers (15 614 cases, 15 433 controls). Evidence of association was convincing for maternal age of 35 years or over (relative risk [RR] 1·31, 95% CI 1·18-1·45), maternal chronic hypertension (odds ratio [OR] 1·48, 1·29-1·70), maternal gestational hypertension (OR 1·37, 1·21-1·54), maternal overweight before or during pregnancy (RR 1·28, 1·19-1·36), pre-eclampsia (RR 1·32, 1·20-1·45), prepregnancy maternal antidepressant use (RR 1·48, 1·29-1·71), and maternal selective serotonin reuptake inhibitor (SSRI) use during pregnancy (OR 1·84, 1·60-2·11). Only two associations, maternal overweight before or during pregnancy and SSRI use during pregnancy, retained their high level of evidence under subset sensitivity analyses. Evidence from biomarkers was scarce, being supported by p values close to the significance threshold and too few cases.

interpretationConvincing evidence suggests that maternal factors, such as age and features of metabolic syndrome, are associated with risk of autism spectrum disorder. Although SSRI use during pregnancy was also associated with such risk when exposed and non-exposed groups were compared, this association could be affected by other confounding factors, considering that prepregnancy maternal antidepressant use was also convincingly associated with higher risk of autism spectrum disorder. Findings from previous studies suggest that one possible confounding factor is underlying maternal psychiatric disorders.

fundingNone.

Indexed as

Maternal AgeAntidepressive AgentsAutism Spectrum DisorderBiomarkersCausalityEnvironmentFemaleHumansPregnancyPregnancy ComplicationsPrenatal Exposure Delayed EffectsRisk FactorsAntidepressive AgentsBiomarkers

Identifiers

PMID31230684
OpenAlexW2952203707

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.