Risk Factors across Prenatal, Perinatal, and Postnatal Stages among Mothers of Children with Autism Spectrum Disorder: A Case–Control Study

Abstract Introduction: Autism spectrum disorder (ASD) is a neurodevelopmental condition characterized by deficits in social interaction, communication, and restricted, repetitive behaviors, typically emerging in early childhood. Despite advances in early diagnosis and intervention, ASD remains a major public health concern worldwide. Its prevalence varies across populations, with a commonly observed male-to-female ratio of 3:1. Although symptoms can appear by 2 years of age, diagnosis is often delayed. In India, limited awareness and diagnostic resources contribute to underreporting and late identification of cases. Objective: The aim of this study was to assess the proportion of prenatal, perinatal, and neonatal risk factors associated with ASD and to identify specific events from pregnancy through the neonatal period that are significantly linked to the development of ASD. Methods: A hospital-based case–control study was conducted from November 2019 to March 2020 at the Institute of Child Health, Egmore, Tamil Nadu. A total of 108 mothers of children aged 3–10 years were enrolled, comprising 54 mothers of children diagnosed with ASD (cases) and 54 mothers of neurotypical children (controls), in a 1:1 ratio. The sample size was estimated based on an assumed exposure rate of 4.2% and 90% power. Data were collected using a semistructured questionnaire assessing prenatal, perinatal, and neonatal factors. Interviews were conducted after obtaining informed consent. Results: Although no significant differences were observed in overall perinatal characteristics, cesarean section deliveries were more common among cases (55.6%) compared to controls (40.7%). Neonatal factors showed significant associations: neonatal intensive care unit (NICU) admission was reported in 31.5% of ASD cases versus 9.3% of controls ( P = 0.004), and delayed birth cry occurred in 27.8% of cases compared to 3.7% of controls ( P = 0.003). Conclusion: This study suggests that neonatal complications, particularly delayed birth cry and NICU admission, are significantly associated with ASD. These findings highlight the importance of monitoring high-risk neonates and underscore the need for larger, multicenter studies to validate these associations and guide early detection strategies.