Risk Factors for Autism Spectrum Disorder in the Middle East and North Africa Region: A Systematic Review and Meta-Analysis of Confounder-Adjusted Studies.

Authors

Aishat F Akomolafe, Fathima R Mahmood, Bushra M Abdallah, Amgad M Elshoeibi, Elhassan Mahmoud, Aisha Abdulla Al-Khulaifi, Nour Darwish, Yara Dweidri, Duaa Yousif, Hafsa Khalid, Majed Al-Theyab, Muhammad Waqar Azeem, Durre Shahwar, Madeeha Kamal, Majid Alabdulla, Salma M Khaled, Tawanda Chivese

Published in

Journal of autism and developmental disorders. Aug 03, 2026. Epub Aug 03, 2026.

Abstract

The etiology of autism spectrum disorder (ASD) is poorly understood, with sparse data from the Middle East and North Africa (MENA) region, which has a unique socio-epidemiological setting. This research investigated early-life developmental risk factors associated with ASD in the MENA region.
In this systematic review and meta-analysis, we searched the PubMed, Embase, Scopus, and CINAHL databases for observational studies that conducted adjusted analyses of ASD risk factors in the MENA region. We analyzed associations between ASD and factors related to conception, inheritance, maternal morbidity during pregnancy and adverse pregnancy outcomes. After study quality assessment, meta-analyses for each risk factor were carried out using a bias-adjusted inverse variance heterogeneity model. Heterogeneity was assessed using I² and publication bias using Doi plots and funnel plots.
The systematic review included 19 case-control studies from eight countries within the MENA region. In overall synthesis, male sex (OR = 3.27, 95% CI: 2.39-4.48, I² = 40.9%), family history of ASD (OR=7.02, 95% CI 3.30-14.95, I² = 85.0%), and consanguinity (OR = 1.77, 95% CI: 1.38-2.28, I² = 57.1%) were associated with ASD. Although with limited studies, a review of the literature showed some possible associations between ASD and gestational diabetes, gestational hypertension, macrosomia, NICU admission, respiratory distress syndrome, cesarean delivery, gestational age, and older maternal age.
These findings confirm the association between male sex, family history of ASD and consanguinity with ASD, potentially suggesting some inherited mechanism in the etiology of ASD in the MENA region. Some maternal co-morbidities during pregnancy and adverse pregnancy outcomes may contribute to higher ASD risk, although more studies are needed in the region.
The protocol for this systematic review and meta-analysis is registered on the International Prospective Register of Systematic Reviews (PROSPERO) with registration ID CRD42024499837.

PMID:
42545631
Bibliographic data and abstract were imported from PubMed on 03 Aug 2026.

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