Prenatal Air Pollution Exposure and Autism Spectrum Disorder in the ECHO Consortium

Akhgar Ghassabian^{1

2}, Aisha S Dickerson³, Yuyan Wang², Joseph M Braun⁴, Deborah H Bennett⁵, Lisa A Croen⁶, Kaja Z LeWinn⁷, Heather H Burris^{8

9}, Rima Habre¹⁰, Kristen Lyall¹¹, Jean A Frazier^{12

13

14}, Hannah C Glass^{15

16

17}, Stephen R Hooper¹⁸, Robert M Joseph¹⁹, Catherine J Karr^{20

21}, Rebecca J Schmidt^{8

22}, Chloe Friedman²³, Margaret R Karagas²⁴, Annemarie Stroustrup^{25

26

27}, Jennifer K Straughen^{28

29}, Anne L Dunlop³⁰, Jody M Ganiban³¹, Leslie D Leve³², Rosalind J Wright³³, Cindy T McEvoy³⁴, Alison E Hipwell³⁵, Angelo P Giardino³⁶, Hudson P Santos Jr³⁷, Hannah Krause³⁸, Emily Oken³⁹, Carlos A Camargo Jr⁴⁰, Jiwon Oh⁸, Christine Loftus²¹, T Michael O'Shea⁴¹, Thomas G O'Connor^{42

43

44}, Adam Szpiro⁴⁵, Heather E Volk^{46

47}; ECHO Cohort Consortium

Affiliations

¹ Department of Pediatrics, NYU Grossman School of Medicine, New York, New York, USA.
² Department of Population Health, NYU Grossman School of Medicine, New York, New York, USA.
³ Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA.
⁴ Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island, USA.
⁵ Department of Public Health Sciences, UC Davis School of Medicine, Sacramento, California, USA.
⁶ Division of Research, Kaiser Permanente Northern California, Oakland, California, USA.
⁷ Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, California, USA.
⁸ Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.
⁹ Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
¹⁰ Department of Population and Public Health Sciences, USC Keck School of Medicine, Los Angeles, California, USA.
¹¹ A.J. Drexel Autism Institute, Drexel University, Philadelphia, Pennsylvania, USA.
¹² Eunice Kennedy Shriver Center, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA.
¹³ Department of Psychiatry, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA.
¹⁴ Department of Pediatrics, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA.
¹⁵ Department of Neurology, University of California San Francisco, San Francisco, California, USA.
¹⁶ Weill Institute for Neuroscience, University of California San Francisco, San Francisco, California, USA.
¹⁷ Department of Pediatrics, UCSF Benioff Children's Hospital, University of California San Francisco, San Francisco, California, USA.
¹⁸ Department of Health Sciences, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA.
¹⁹ Department of Anatomy and Neurobiology, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts, USA.
²⁰ Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA.
²¹ Department of Environmental and Occupational Health Sciences, University of Washington School of Public Health, Seattle, Washington, USA.
²² The MIND Institute, University of California Davis, Sacramento, California, USA.
²³ Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.
²⁴ Department of Epidemiology, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA.
²⁵ Division of Neonatology, Cohen Children's Medical Center, Northwell Health, New Hyde Park, New York, USA.
²⁶ Department of Pediatrics, Zucker School of Medicine at Hofstra/Northwell, Uniondale, New York, USA.
²⁷ Department of Occupational Medicine, Epidemiology and Prevention, Zucker School of Medicine at Hofstra/Northwell, Uniondale, New York, USA.
²⁸ Department of Public Health Sciences, Henry Ford Health, Detroit, Michigan, USA.
²⁹ Department of Obstetrics, Gynecology and Reproductive Biology, College of Human Medicine, Michigan State University, East Lansing, Michigan, USA.
³⁰ Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia, USA.
³¹ Department of Psychological and Brain Sciences, George Washington University, Washington, DC, USA.
³² Prevention Science Institute, University of Oregon, Eugene, Oregon, USA.
³³ Department of Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
³⁴ Department of Pediatrics, Papé Pediatric Research Institute, Oregon Health and Science University, Portland, Oregon, USA.
³⁵ Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
³⁶ Department of Pediatrics, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, Utah, USA.
³⁷ University of Miami, School of Nursing and Health Studies, Miami, Florida, USA.
³⁸ Vanderbilt University Medical Center, Nashville, Tennessee, USA.
³⁹ Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Cambridge, Massachusetts, USA.
⁴⁰ Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
⁴¹ Division of Neonatal-Perinatal Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
⁴² Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA.
⁴³ Department of Neuroscience, University of Rochester Medical Center, Rochester, New York, USA.
⁴⁴ Department of Obstetrics and Gynecology, University of Rochester Medical Center, Rochester, New York, USA.
⁴⁵ Department of Biostatistics, University of Washington School of Public Health, Seattle, Washington, USA.
⁴⁶ Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
⁴⁷ Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.

PMID: 40498638
DOI: 10.1289/EHP16675

Free article

Prenatal Air Pollution Exposure and Autism Spectrum Disorder in the ECHO Consortium

Akhgar Ghassabian et al. Environ Health Perspect. 2025.

Free article

. 2025 Jun 11.

doi: 10.1289/EHP16675. Online ahead of print.

Authors

Affiliations

¹ Department of Pediatrics, NYU Grossman School of Medicine, New York, New York, USA.
² Department of Population Health, NYU Grossman School of Medicine, New York, New York, USA.
³ Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA.
⁴ Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island, USA.
⁵ Department of Public Health Sciences, UC Davis School of Medicine, Sacramento, California, USA.
⁶ Division of Research, Kaiser Permanente Northern California, Oakland, California, USA.
⁷ Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, California, USA.
⁸ Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.
⁹ Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
¹⁰ Department of Population and Public Health Sciences, USC Keck School of Medicine, Los Angeles, California, USA.
¹¹ A.J. Drexel Autism Institute, Drexel University, Philadelphia, Pennsylvania, USA.
¹² Eunice Kennedy Shriver Center, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA.
¹³ Department of Psychiatry, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA.
¹⁴ Department of Pediatrics, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA.
¹⁵ Department of Neurology, University of California San Francisco, San Francisco, California, USA.
¹⁶ Weill Institute for Neuroscience, University of California San Francisco, San Francisco, California, USA.
¹⁷ Department of Pediatrics, UCSF Benioff Children's Hospital, University of California San Francisco, San Francisco, California, USA.
¹⁸ Department of Health Sciences, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA.
¹⁹ Department of Anatomy and Neurobiology, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts, USA.
²⁰ Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA.
²¹ Department of Environmental and Occupational Health Sciences, University of Washington School of Public Health, Seattle, Washington, USA.
²² The MIND Institute, University of California Davis, Sacramento, California, USA.
²³ Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.
²⁴ Department of Epidemiology, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA.
²⁵ Division of Neonatology, Cohen Children's Medical Center, Northwell Health, New Hyde Park, New York, USA.
²⁶ Department of Pediatrics, Zucker School of Medicine at Hofstra/Northwell, Uniondale, New York, USA.
²⁷ Department of Occupational Medicine, Epidemiology and Prevention, Zucker School of Medicine at Hofstra/Northwell, Uniondale, New York, USA.
²⁸ Department of Public Health Sciences, Henry Ford Health, Detroit, Michigan, USA.
²⁹ Department of Obstetrics, Gynecology and Reproductive Biology, College of Human Medicine, Michigan State University, East Lansing, Michigan, USA.
³⁰ Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia, USA.
³¹ Department of Psychological and Brain Sciences, George Washington University, Washington, DC, USA.
³² Prevention Science Institute, University of Oregon, Eugene, Oregon, USA.
³³ Department of Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
³⁴ Department of Pediatrics, Papé Pediatric Research Institute, Oregon Health and Science University, Portland, Oregon, USA.
³⁵ Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
³⁶ Department of Pediatrics, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, Utah, USA.
³⁷ University of Miami, School of Nursing and Health Studies, Miami, Florida, USA.
³⁸ Vanderbilt University Medical Center, Nashville, Tennessee, USA.
³⁹ Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Cambridge, Massachusetts, USA.
⁴⁰ Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
⁴¹ Division of Neonatal-Perinatal Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
⁴² Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA.
⁴³ Department of Neuroscience, University of Rochester Medical Center, Rochester, New York, USA.
⁴⁴ Department of Obstetrics and Gynecology, University of Rochester Medical Center, Rochester, New York, USA.
⁴⁵ Department of Biostatistics, University of Washington School of Public Health, Seattle, Washington, USA.
⁴⁶ Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
⁴⁷ Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.

PMID: 40498638
DOI: 10.1289/EHP16675

Abstract

Background: The relationship between prenatal exposure to low-level air pollution and child autism spectrum disorder (ASD) is unclear.

Objective: To examine associations of prenatal air pollution exposure with autism.

Methods: We analyzed data from 8,035 mother-child pairs from 44 United States cohorts in the Environmental influences on Child Health Outcomes (ECHO) Cohort. Fine particulate matter (PM_2.5), nitrogen dioxide (NO₂), and 8-hour-max ozone (O₃) levels were estimated at residential addresses during pregnancy. Parents rated children's autism-related traits using the Social Responsiveness Scale (SRS) (mean age 9.4 years, SD=3.6) and reported physician-diagnosed ASD. We examined associations of the three air pollutants with SRS scores (10^th, 50^th, and 90^th quantiles) using quantile regression and with ASD diagnosis using logistic regression. Models were run within census divisions, and coefficients were pooled in a meta-analysis.

Results: Average (SD) pregnancy exposures were 9.3 µg/m3 (2.7) for PM_2.5, 21.8 ppb (8.8) for NO₂, and 40.3 ppb (5.5) for O₃, with variations across census divisions. The median SRS T-score was 46 (IQR=41 to 52), and 444 children (5.5%) had an ASD diagnosis. Higher PM_2.5 was associated with higher SRS scores at the 10^th quantile (β=0.74, 95% CI: 0.09, 1.40) but not at the median or highest quantile. The association between PM_2.5 and ASD diagnosis was highly heterogeneous, with associations present in the South Central, Mountain, and Pacific census divisions. Heterogeneity was also high in the association between NO₂ and SRS at the median and only in the mid-Atlantic, West North Central, and South Atlantic census divisions. Higher O₃ was associated with higher SRS scores at the median (β per IQR increment=0.83, 95% CI: 0.05, 1.61) and highest quantile (β=2.19, 95% CI: 0.06, 4.32) in the meta-analysis. Higher O₃ also was associated with ASD.

Discussion: Associations with ASD outcomes were present even at low levels of air pollutants. https://doi.org/10.1289/EHP16675.

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Prenatal Air Pollution Exposure and Autism Spectrum Disorder in the ECHO Consortium

Affiliations

Prenatal Air Pollution Exposure and Autism Spectrum Disorder in the ECHO Consortium

Authors

Affiliations

Abstract

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