Asociación entre exposiciones materno-fetales y el riesgo de trastorno del espectro autista: revisión sistemática y metaanálisis
Association between maternal-fetal exposure and the risk of autism spectrum disorder: systematic review and meta-analysis
Resumen
RESUMEN El trastorno del espectro autista (TEA) es una alteración del neurodesarrollo de etiología multifactorial, asociada con la interacción entre susceptibilidad genética y exposiciones maternas, prenatales, perinatales y parentales. El objetivo fue sintetizar la evidencia disponible sobre la asociación entre estas exposiciones y el riesgo de TEA. Se realizó una búsqueda bibliográfica en las bases de datos de Scopus, Web of Science y PubMed siguiendo las directrices PRISMA 2020. Se incluyeron 25 estudios observacionales publicados entre 2020 y 2026, de los cuales 18 aportaron medidas de asociación compatibles con la síntesis cuantitativa. El metaanálisis se efectuó mediante modelos de efectos fijos y aleatorios con estimador DerSimonian-Laird; además, se evaluó la heterogeneidad, el sesgo de publicación y la estabilidad de los resultados mediante análisis de sensibilidad leave-one-out. El modelo de efectos fijos mostró una medida relativa de asociación combinada de 1.157 (IC 95%: 1.133-1.182), mientras que el modelo de efectos aleatorios obtuvo una medida relativa combinada de 1.394 (IC 95%: 1.243-1.563; p<0.001), con heterogeneidad considerable (I2 = 94.94%). El análisis por subgrupos mostró las asociaciones estadísticamente significativas para las condiciones maternas clínicas, metabólicas, infecciosas y reproductivas, el uso de medicamentos en el embarazo y las exposiciones ambientales. En contraste, factores obstétricos y perinatales y el grupo de tabaco, cannabis y otras sustancias no alcanzaron significancia estadística. En conjunto, los hallazgos respaldan una asociación multifactorial entre diversas exposiciones materno-fetales y el riesgo de TEA y destacan la importancia del control prenatal.
ABSTRACT Autism spectrum disorder (ASD) is a neurodevelopmental disorder of multifactorial etiology, associated with the interaction between genetic susceptibility and maternal, prenatal, perinatal and parental exposures. The aim was to synthesize the available evidence on the association between these exposures and the risk of ASD. A literature search was conducted in the Scopus, Web of Science and PubMed databases in accordance with the PRISMA 2020 guidelines. Twenty-five observational studies published between 2020 and 2026 were included, of which 18 provided measures of association suitable for quantitative synthesis. The meta-analysis was performed using fixed-effect and random-effects models with the DerSimonian-Laird estimator; furthermore, heterogeneity, publication bias and the stability of the results were assessed using leave-one-out sensitivity analyses. The fixed-effects model showed a combined relative risk of 1.157 (95% CI: 1.133–1.182), whilst the random-effects model yielded a combined relative risk of 1.394 (95% CI: 1.243–1.563; p<0.001), with considerable heterogeneity (I² = 94.94%). Subgroup analysis revealed statistically significant associations for maternal clinical, metabolic, infectious and reproductive conditions, the use of medication during pregnancy, and environmental exposures. In contrast, obstetric and perinatal factors, and the group comprising tobacco, cannabis and other substances, did not reach statistical significance. Taken together, the findings support a multifactorial association between various maternal-fetal exposures and the risk of ASD and highlight the importance of prenatal care.
Recibido: 24-07-2026.
Aceptado: 02-09-2026.
Publicado: 25-09-2026
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Depósito Legal Electrónico: ME2016000090
ISSN Electrónico: 2610-797X
DOI: https://doi.org/10.53766/GICOS
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