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A la recherche de facteurs de risque périnatals de l’autisme (Dr Jean-Marc Retbi, Journal International de Médecine)

Les Troubles du Spectre Autistique [TSA] sont attribués pour partie à des facteurs périnatals, au sens large, qui perturbent le développement cérébral. E Hisle-Gorman et coll. ont recensé 29 associations de conditions et/ou d’expositions à des médicaments durant la grossesse, l’accouchement et la période néonatale avec des diagnostics ultérieurs de TSA. Leur étude cas-témoins rétrospective teste l’hypothèse que l’évaluation simultanée de tous les facteurs de risque périnatals publiés, dans une vaste cohorte, permet d’identifier une série plus restreinte d’associations.

Au cours des années 2000-2013, 8 760 enfants de 2 à 18 ans, enregistrés dans la base de données du Military Health System des USA, ont reçu un diagnostic de TSA à au moins deux reprises, d’après les codes de la CIM-9 –syndrome de Rett exclu-. Chacun d’eux a été apparié à trois témoins de date de naissance et de sexe identiques.Les associations significatives entre les facteurs de risque périnatals et les TSA sont identifiées en utilisant une régression logistique conditionnelle.Six facteurs de risque ne sont pas retenus dans le modèle final après sélection des variables par la méthode LASSO : une maladie auto-immune, une maladie cœliaque, une anémie, une toxicomanie chez la mère, une grossesse multiple, et le dépassement de terme. Et deux facteurs ne sont pas significatifs dans ce modèle : les complications de la grossesse et la prématurité (p corrigé > 0,05).

3 facteurs significatifs : convulsions néonatales, maladie mentale et épilepsie maternelles
Les pathologies qui demeurent associées aux TSA comprennent : chez la mère, une maladie mentale, une épilepsie, une obésité, une hypertension artérielle, un diabète, des ovaires polykystiques [OPK], des infections, un asthme, une assistance à la procréation, les vomissements gravidiques, et un âge < 25 ans ; les complications de l’accouchement ; et chez le bébé, un petit poids de naissance, une infection, des convulsions, une asphyxie et des complications néonatales. Six des affections maternelles précitées ne sont des facteurs de risque significatifs qu’en combinaison avec leur traitement médicamenteux ou seulement par leur traitement médicamenteux : les infections, le diabète, la maladie mentale, les OPK, l’assistance à la procréation, et l’épilepsie. Les médicaments peuvent être soit les marqueurs de la sévérité de ces conditions, soit les agents directs des TSA. Les pathologies néonatales associées aux TSA étayent l’idée que l’augmentation de la prévalence des TSA est due, au moins en partie, à la survie de nouveau-nés à risque élevé (petits poids de naissance avec des complications, asphyxie néonatale, etc.).
En définitive, les trois facteurs de risque de TSA les plus importants sont les convulsions néonatales (Odds Ratio ajusté [ORa] : 7,57 ; Intervalle de Confiance de 95 % [IC95 %] : 5,68-10,07), une maladie mentale maternelle (OR : 1,80 ; IC95 % : 1,65-1,96) et une épilepsie maternelle (OR : 1,60 ; IC95 % : 1,02-2,50).Les associations avec les traitements maternels, non détaillés dans l’étude, un jeune âge maternel, en contradiction avec les résultats d’études antérieures, et les lésions cérébrales néonatales méritent d’être approfondies. Ceci étant, les résultats de cette étude suggèrent que l’étiologie des TSA est multifactorielle et qu’aucun facteur de risque périnatal n’est vraisemblablement suffisant à lui seul pour provoquer des TSA.

 

RÉFÉRENCE
Hisle-Gorman E et coll. : Prenatal, perinatal, and neonatal risk factors of autism spectrum disorder. Pediatr Research., 2018 ; 84 : 190-198.

 

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  1. Your point of view caught my eye and was very interesting. Thanks. I have a question for you.

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