Perinatal and neonatal factors associated with autism spectrum disorder in palestine: a matched case–control study

Autism spectrum disorder (ASD) is a complex neurodevelopmental condition with multifactorial etiology. Increasing evidence suggests that perinatal and neonatal factors may contribute to ASD; however, data from low-and middle-income countries, particularly in the Middle East, remain limited. To investigate the association between selected perinatal and neonatal factors and ASD among children in Palestine. A frequency matched case–control study was conducted including 90 children diagnosed with ASD and 180 age- and sex-matched controls (1:2 ratio), aged 2–18 years. ASD diagnoses were confirmed by pediatric neurologists or developmental specialists using DSM-5 criteria and standardized assessment tools. Data on perinatal and neonatal exposures were collected through structured parental interviews and verified by medical records. Univariable logistic regression was used to estimate crude odds ratios, and multivariable Firth penalized likelihood logistic regression was used to estimate adjusted odds ratios (aORs) with 95% confidence intervals (CIs). In the Firth penalized multivariable model, non-cephalic fetal presentation (aOR 10.52, 95% CI 2.15, 103.09), congenital anomalies at birth (aOR 7.38, 95% CI 1.20, 82.00), and infantile colic (aOR 3.29, 95% CI 1.37, 8.16) were associated with higher odds of ASD. Infantile colic remained consistent across sensitivity models, whereas the congenital-anomaly estimate was less precise in Sensitivity Model B. Several perinatal and neonatal factors were associated with ASD in this Palestinian cohort. These findings should be interpreted as associations rather than evidence of causality and underscore the importance of enhanced developmental surveillance for children exposed to adverse early-life conditions. Larger prospective studies are warranted to clarify causal pathways.