Early life factors and autism spectrum disorder: an exploratory case–control study from Kasr Al-Aini hospitals

Abstract Background Autism spectrum disorder (ASD) is multifactorial and increasingly recognized in low- and middle-income settings. Clarifying early-life factors in Egypt may inform prevention and early guidance. Methods We conducted a case–control study at Kasr Al-Ainy Psychiatry Hospital (cases) and the surrounding community (controls) between November 2023 and November 2024, including 52 children with ASD and 101 neurotypical controls aged 2–12 years. Mothers’ Interviews ascertained prenatal and early-life exposures. Tests of hypotheses and logistic regressions were conducted after adjusting for age and sex using Jamovi (version 2.3.24 for Windows 11). Results Breastfeeding practices were not significantly associated with ASD. Patterns of early screen exposure showed significant associations: daily screen time > 6 h before age two was more frequent in ASD than controls (32.0% vs 8.2%; p < 0.001), and interactive engagement during early screen use was protective (OR = 0.25, 95% CI 0.12–0.52). Children first exposed continuously at ages 2–3 years had lower ASD odds than those first exposed after age 3 (OR = 0.21, 95% CI 0.05–1.00). Early antibiotic exposure showed inverse associations in adjusted models: 2–3 courses before age 2 (OR = 0.17, 95% CI 0.05–0.54) and 3–6 courses (OR = 0.30, 95% CI 0.10–0.93). Male sex (OR = 2.64, 95% CI 1.22–5.69), older paternal age at delivery (OR per year = 1.07, 95% CI 1.02–1.12), and maternal psychiatric disorders during pregnancy (OR = 6.27, 95% CI 1.14–34.36) were associated with higher ASD odds; maternal diabetes, hypertension, delivery complications, cesarean delivery, and preterm birth were not. Conclusion In our study, early non-interactive screen exposure and patterns of antibiotic use showed associations with ASD. At the same time, male sex, older paternal age, and maternal psychiatric disorders were notable secondary correlates. Future studies are needed to confirm these associations and inform early preventive strategies.