Perinatal Risk Factors among Iraqi Children with Autism Spectrum Disorder: A Case–Control Study

Abstract

Background: Autism spectrum disorder (ASD) is a neurodevelopmental condition characterized by deficits in social communication and restricted, repetitive behaviors. Increasing evidence suggests that prenatal, perinatal, and postnatal factors contribute to ASD risk, with variations across populations. Objectives: To assess the prevalence of prenatal, perinatal, and postnatal risk factors among Iraqi children with ASD and to evaluate their association with ASD occurrence. Materials and Methods: A case–control study was conducted between April and June 2024 in Kerbala, Iraq. Children diagnosed with ASD according to DSM-5 criteria were enrolled as cases, while children without neurodevelopmental disorders served as controls. Data were collected through structured face-to-face interviews with mothers. Results: Eighty-two children with ASD and 164 controls were included. ASD was more frequent among males and children living in urban areas. Maternal emotional distress during pregnancy was associated with increased odds of ASD. Maternal anemia, infections, and medication use during pregnancy were associated with lower odds of ASD. Neonatal respiratory distress and neonatal feeding difficulties were significantly associated with ASD. Maternal age at conception was an independent predictor of ASD, whereas paternal age was not. Conclusion: Several prenatal and postnatal factors were associated with ASD in Iraqi children. Maternal stress during pregnancy, neonatal respiratory distress, and feeding difficulties increased ASD risk, while maternal age was the strongest parental predictor. These findings emphasize the importance of maternal health and early neonatal care.