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Med Hypotheses. 2019 Jun;127:26-33. doi: 10.1016/j.mehy.2019.03.012. Epub 2019 Mar 23.

Improving autism perinatal risk factors: A systematic review.

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Lake Erie College of Osteopathic Medicine Health-Millcreek Community Hospital, Erie, PA 16509, United States.
Center for Environmental Research and Children's Health (CERCH), School of Public Health, University of California, Berkeley, United States.
UCSF Department of Psychiatry & Langley Porter Psychiatric Institute, United States.
Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, United States.
UCSF Department of Psychiatry & Langley Porter Psychiatric Institute, UCSF Weill Institute for Neurosciences, 401 Parnassus, LP-119, San Francisco, CA 94143-0984, United States. Electronic address:



Current understanding of the etiology of autism is based on the interaction of multiple genes with each other and with environmental factors, leading to a neurodevelopmental process that results in the expression of autism spectrum disorder (ASD) in the child. This suggests that it might be possible to strengthen resilience to environmental stressors during the perinatal period to improve outcomes and possibly prevent the development of ASD.


We searched the MEDLINE database for multiple perinatal factors associated with the development of ASD published between January 1, 2005 and July 1, 2018. The search terms used were "autism" crossed with either "perinatal," "prenatal," "gestational," or "pregnancy," and crossed again with each perinatal risk factor highlighted in this review including topics on parental health, infections, medications, and environmental stressors. We then searched interventions that may improve neurodevelopmental outcome before and during pregnancy, including supplements, breastfeeding, and postpartum stress reduction. We identified recent or unique metanalyses and systematic reviews of the identified focus and on randomized controlled trials and summarized these using the most recent and comprehensive reviews.


Folate, omega-3, vitamin D3, environmental toxin avoidance, correcting deficiencies, immune boosting, and prolonged breast feeding are all reported to be linked to the possible reduction of adverse pregnancy outcomes including ASD.


Studies of individual components for improving pregnancy outcomes and several uncontrolled preconception to infancy medical practices suggest that multiple interventions might improve the outcomes of pregnancies where there is risk for developing ASD.


Medicine; Pregnancy; Risk

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