Association Between Autism-Like Behavior And Maternal Indoor Air Pollution During Pregnancy In Children Aged 3 To 10 Years In Hefei City

ObjectiveTo analyze the correlation between maternal indoor air pollution during pregnancy and autism-like behavior in children aged 3 to 10 years,and further explore the high-risk indoor environmental factors of children suffering from autism during pregnancy,so as to provide scientific basis and theoretical support for the etiological research and targeted prevention of autism in children.MethodsFrom September to November 2022,children aged 3 to 10 who met the inclusion criteria were selected from 36 kindergartens and 22 primary schools in a district of Hefei City,Anhui Province as the research objects the self-compiled Children Mental Health Screening Questionnaire was released by Wenjuanxing Platform(https://www.wjx.cn/).The screening content of this study included the general conditions of children and parents,the Clancy behavior scale(CBS),the conditions of mothers during pregnancy and children at birth,and the exposure of indoor air pollution.Using X~2 test analyze the sample 3-10 years old children with autism-like behavior related factors affecting the detection rate of distribution,multivariate Logistic regression analysis model and decision tree model were used to comprehensively analyze the association between maternal exposure to indoor air pollution factors(including passive smoking,cooking oil fumes,mosquito coil use,indoor incense burning,et al.)and autism-like behavior in children aged 3 to 10 years.The statistical interactions between variables with statistical differences were analyzed using interaction.The dose-response relationship between cooking duration during pregnancy and risk of developing autism-like behaviors was discussed using restricted cubic spline(RCS)model.And construct a nomogram to visually predict the risk of autism-like behavior.Results(1)A total of 12 622 children met the inclusion criteria in this study,among which 471 had autism-like behavior,with a detection rate of 3.73%.Univariate analysis showed that:Children’s gender(X~2=31.925,P<0.001),mother’s level of education(X~2=30.433,P<0.001),father’s level of education(X~2=15.015,P=0.002),before or during pregnancy folic acid(X~2=11.714,P=0.001),neonatal hemolysis(X~2=4.919,P=0.027),the feeding way(X~2=9.138,P=0.010)and passive smoking history(X~2=24.663,P<0.001),contact cook lampblack(X~2=51.975,P<0.001),cooking average hours per week(X~2=19.246,P<0.001),and cooking ventilation mode(X~2=34.712,P<0.001),contact history of mosquito coils(X~2=40.429,P<0.001),and family indoor incense history(X~2=32.816,P<0.001)was associated with the presence or absence of autism-like behavior.(2)Multivariate Logistic regression analysis results showed that the risk of autism-like behavior was 71%higher for passive smoking than for behaviors without passive smoking exposure(95%CI:1.35-2.17,P<0.001).Exposure to cooking fumes was associated with an increased risk of autism-like behavior,with occasional exposure being 66%(95%CI:1.26-2.20,P<0.001);The risk of frequent exposure was2.40 times higher than that of non-exposure(OR=2.40,95%CI:1.73-3.33,P<0.001).The risk of almost daily exposure was 2.49 times that of non-exposure(OR=2.49,95%CI:1.80-3.43,P<0.001).Compared with no cooking,0-600 min group increased the risk of autism-like behavior by 33%(95%CI:1.09-1.63,P=0.005),and>600 min group added the risk by 55%(95%CI:1.11-2.04,P=0.009).Opening doors and windows while cooking had a 39%lower risk of developing autism-like behavior compared with no ventilation measures(95%CI:0.39-0.94,P=0.025).The risk of turning on the range hood/exhaust fan was reduced by 60%(95%CI:0.27-0.61,P<0.001).Mosquito repellent incense exposure was a risk factor for autism-like behavior,with exposure 1.83 times higher than non-exposure(OR=1.83,95%CI:1.50-2.23,P<0.001).Compared with no indoor incense burning history,the risk of indoor incense burning experience was 2.06 times higher than that of indoor incense burning history(OR=2.06,95%CI:1.58-2.69,P<0.001).The results of decision tree model showed that the correlation degree of factors related to the risk of autism-like behavior was successively as follows:cooking fumes,cooking ventilation,children’s gender,incense burning history,the age of the father at birth,and passive smoking.The combined factors of the two models were:passive smoking,cooking fumes,average weekly cooking time,cooking ventilation,mosquito repellent incense,and incense burning history.Common factors were:of passive smoking,cooking fumes,cooking ventilation,incense burning history.(3)Interaction results showed that there was a additive action between the history of passive smoking and incense burning.Exposure to passive smoking and indoor incense burning was associated with a 2.74 fold higher risk of ASD than the control group(indicating no passive smoking and no exposure to incense burning)(OR=2.74,95%CI:1.71-4.37,P<0.001).(4)RCS results showed that there was a dose-response relationship between average weekly cooking time and risk of autism-like behavior during pregnancy,and the peak was reached when the total cooking time was about 500 min(OR=1.48,95%CI:1.16-1.88).(5)The nomogram showed that cooking exposure to fumes has the greatest effect on the occurrence of autism-like behavior.ConclusionMaternal exposure to passive smoking,cooking,mosquito repellent incense and incense burning during pregnancy may increase the risk of autism-like behavior in children aged 3 to 10 years,and there is a additive action between passive smoking and exposure to indoor incense smoke,when both are present,the risk is greater than exposure to either factor alone.