A large study from Lund University in Sweden connects prematurity with a higher likelihood of autism spectrum disorder in children. The research tracked more than four million Swedish babies born between 1973 and 2013 who survived to age one and followed them for ASD outcomes through 2015.
Results show that ASD prevalence shifts with how early a baby is born. Extremely preterm infants born at 22 to 27 weeks have an ASD prevalence near 6 percent. Those born at 28 to 37 weeks show about 1.9 to 2.1 percent for the extremely and moderately preterm groups, and around 1 percent for babies born at 32 to 37 weeks. Globally, the World Health Organization estimates roughly 15 million babies are born prematurely each year, which means about one in ten children are at elevated ASD risk. In 2021 Russia reported a premature birth rate near 6 percent according to Rosstat.
Premature birth can result from several factors, including infections, excess amniotic fluid, and multiple pregnancies. Medical professionals at Lifeline Reproductive and Family Planning Center emphasize that a shortened pregnancy with cervical dilation and effacement is a common contributor to prematurity. A body mass index over 30 raises the risk of pregnancy complications such as edema, preeclampsia, and high blood pressure, all of which can influence the likelihood of early delivery.
Geneticist Yulia Zinovieva notes that prematurity may increase risks for delays in motor and language development alongside ASD features. She explains that extremely premature infants often face intrauterine growth restriction, risks of hypoxia, and possible intrauterine death, with some surviving but showing varying degrees of pathology, including autism.
Premature children may experience incomplete brain development relative to their oxygen needs. Subtle cortical and basal ganglia changes can contribute to developmental delays. Advances in neonatal care have improved survival for those born very early, which can shape contemporary ASD prevalence patterns seen today.
Further work by researchers such as BV Petrovsky and Natalia Ustinova indicates that prematurity is not the sole determinant of neurodevelopmental disorders. It is one of many contributing factors in a landscape that includes metabolic disorders, diabetes, nutrition, and maternal body mass index. The link between prematurity and ASD is not necessarily causal; shared genetic and environmental influences may affect both prematurity and autism.
ASD is recognized as multifactorial. Scientists agree that multiple pathways can lead to autistic traits and that several etiologies may produce similar behavioral outcomes. Experts suggest that identifying a single cause for autism is unlikely. The focus is on understanding how diverse factors interact to shape neurodevelopment.
Researchers also consider the brain–gut axis, noting that gut microbiota can influence brain development and function. A holistic, personalized approach to ASD care is increasingly viewed as essential, spanning early intervention, education, and ongoing medical support.
Experts emphasize that while prematurity is a risk factor, it does not determine outcomes. Clinical experience shows that even among children born at similar gestational ages, results can vary widely. Some achieve full physical and cognitive health, while others face significant challenges. Rehabilitation and early, targeted therapies often lead to meaningful improvements in many cases.
Fetal programming offers a framework for prevention. Environmental cues during fetal development may influence lifelong health trajectories, underscoring the importance of healthy lifestyle choices for expectant families and careful avoidance of exposures that could heighten ASD risk. Preventive strategies include thorough prenatal care, timely infection treatment, and regular gynecological visits to monitor progression of pregnancy.
In addition, preventing premature birth involves careful medical supervision before birth and preparation for pregnancy. Routine screenings, preventive care, and prompt management of infections contribute to healthier pregnancy outcomes and potentially lower ASD risk in offspring. The discussion around ASD remains nuanced, with ongoing research exploring how prenatal and perinatal factors intersect with genetic and environmental influences to shape neurodevelopment. Multiple studies support the view that a single cause is unlikely, making a nuanced, comprehensive approach essential for understanding and supporting affected individuals. [citation]