Prematuridade e transtorno do espectro autista (TEA): revisão integrativa da literatura

Abstract

The prevalence of autism spectrum disorder (ASD) has increased significantly in recent years and prematurity is recognized as a risk factor. The present study aimed to gather current evidence on the relationship between prematurity and ASD. An integrative literature review was performed, including original articles published in full, in English, Portuguese and Spanish, published between January 2012 and March 2022. The electronic search was performed on PubMed databases (National Institutes of Health's National Library of Health), SciELO, MEDLINE (National Library of Medicine) and Lilacs (Latin American and Caribbean Literature on Health Sciences), using the combination of the following descriptors (“autism spectrum disorder”; “disorder, autistic”; “premature birth”; and “risk factor”). To complement the electronic search, a manual search was performed to identify potentially eligible studies that were not located. 124 articles were located in the electronic search. With the application of the established inclusion criteria, nineteen articles were selected for this review. The results indicate a high prevalence (1.8% and 41%) of ASD in prematurity, associated with gestational age at birth. Other factors were also associated with ASD, such as low birth weight, perinatal asphyxia, small-for-gestational-age classification, male sex, brain dysfunction, severe bronchopulmonary dysplasia, postnatal steroid use, late bacteremia, prolonged hospital stay, minor maternal education, non-white mothers, maternal depression, co-existing disabilities, and developmental delays. Signs of ASD can be observed in the first months of life, persisting into adolescence and adulthood, associated with intellectual disability, language impairment and behavioral difficulties. The present review suggests that prematurity is a risk factor for ASD, but it is still unclear in the literature whether ASD is related to prematurity itself or to the comorbidities associated with it. Signs of ASD can be observed in the first months of life, favoring referral for early intervention. Intellectual disability, language impairment and behavioral difficulties can further impair functional performance in ASD.