PREVALENCE AND IDENTIFICATION OF ENVIRONMENTAL

(PRENATAL, INTRANATAL, POSTNATAL) FACTORS AS PREDICTORS

OF AUTISM SPECTRUM DISORDERS

A. Anugrah Santikala 1, Martira Maddepungeng 2, Dasril Daud 3

1
Pediatric Department, Faculty of Medicine, Universitas Hasanuddin, Makassar
(Email: anugrah_santikala@yahoo.co.id)
2
Pediatric Department, Faculty of Medicine, Universitas Hasanuddin, Makassar
(Email: martiara711@yahoo.com)
3
Pediatric Department, Faculty of Medicine, Universitas Hasanuddin, Makassar
(Email: drdasril@gmail.com)

Correspondence Address:

A. Anugrah Santikala
Pediatric Department, Faculty of Medicine
Universitas Hasanuddin
Makassar, 90245
HP : 085342041980
Email : anugrah_santikala@yahoo.co.id

0
Abstract

Autism Spectrum Disorders (ASD) is a complex neurodevelopmental disorder. The aims of this study were to
determine the prevalence of Autism Spectrum Disoder in Makassar city and continued with identification of
prenatal environmental factors (maternal age, hyperemesis gravidarum, antenatal bleeding, PROM), intranatal
(premature, LBW, asphyxia, birth trauma), and postnatal (neonatal jaundice, seizures,-exclusive breastfeeding,
DHA and AA formula milk) as significant factors in incidence of ASD. This study is a case control study design,
with 1300 children aged 18 months - 6 years from PAUD (Early age child Education), children who was brought
for immunization at the posyandu, and/or for clinical checkups at Biringkanaya, Manggala, Panakukang,
Tamalate and Rappocini in Makassar city from February to June 2018. Data were collected with interviews and
questionnaires. The results showed the prevalence of ASD in Makassar city was 1.69%. Bivariate analysis
showed that significant environmental factors were asphyxia (p = 0.032 OR = 3.835 95% CI 1.264-11.653),
delivery trauma (p = 0.042 OR = 4.428 95% CI 1.263-15.522), and exclusive breastfeeding (p = 0.000 OR =
0.219 95% CI 0.091-0.526). Logistic multiple regression analysis showed that exclusive breastfeeding were
significant in the incidence of ASD (p = 0.001 OR 0.233 95% CI 0.096 - 0.565). Exclusive breastfeeding had a
protective value of 0,233 times on the incidence of ASD.

Keywords: prenatal, intranatal, postnatal factors, autism

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INTRODUCTION
Autism spectrum disorders (ASD) are neurodevelopmental disorders in the early
childhood which are characterized by impairment in language aspect and social interaction as
well as the presence of repetitive / stereotypic behavior (Prasad et al., 2009; Adamsen et al.,
2010).
ASD is a very complex developmental disorder, beginning to appear before the age of
3 years (Pratiwi & Dieny, 2014). An individual with ASD disorder exhibit a variety of
neurobehavioral phenotypes which are characterized by qualitative disturbances in social
interaction, communication disorders, and stereotypic behavior patterns in the form of limited
activity and attention which are usually accompanied by broad spectrum manifestations such
as: response to unusual stimuli, motor patterns, less sensitive to pain, indigestion, anxiety,
sleep and attention disorder, aggressive, and self-injuring (Zafeiriou et al., 2009). This
condition inflicts inability to communicate or express their desires, resulting in disruption of
behavior and relationships with others (Pratiwi & Dieny, 2014).
The incidence of autism has increased significantly over the years. According to a
study over the past 50 years, the prevalence of autism has increased worldwide. Based on the
data from Centers for Disease Control and Prevention (CDC), the prevalence of ASD
increased from 6.7% (1: 150) in 2000 to 14.7% (1: 68) in 2010 (Tchaconas et al., 2013).
In the United States in March 2013, it was reported that the prevalence of autism
increased to 1:50 in the past year. This is not only happening in developed countries such as
Britain, Australia, Germany and America, but also in developing countries like Indonesia. The
prevalence of autism in the world currently reaches 15-20 cases per 10,000 children or ranges
from 0.15 to 0.20%. If the birth rate in Indonesia is 6 million per year, the number of people
with autism in Indonesia increases by 0.15% or 6,900 children per year (Pratiwi & Dieny,
2014).
Exact data on autism in Indonesia still does not exist, but the incidence seems to
increase. South Sulawesi is one of the provinces in Indonesia with a number of people with
autism. Based on outpatient visit data for growth and development polyclinic at Wahidin
Sudirohusodo General Hospital, new patients diagnosed with ASD in 2012 were 25 patients,
14 patients in 2013, 24 patients in 2014, 20 patients in 2015 and 26 patients in 2016.
ASD is more common in boys than girls with a 4: 1 ratio. The spectrum of ASD cases
varies greatly and there is no evidence of a relationship between ASD and certain social
classes or ethnic (Ratajczak, 2011; Rice, 2011).

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 ASD is a phenomenon that still holds many secrets even though it has been studied
more than 60 years ago. Until now there is no definite cause of this disorder, presumably
multifactorial. There are studies that report prenatal, perinatal and postnatal risk factors
associated with the incidence of ASD. Prenatal factors include maternal and father’s age,
bleeding in pregnancy, use of psychotropic drugs, and diabetes, while perinatal factors include
types of risk delivery, complications during delivery, neonatal asphyxia, prematurity, and
LBW. Reported postnatal factors include hyperbilirubinemia, neonatal encephalopathy
(Guinchat et al., 2012).
Previous study by Maddeppungeng (2014) in Makassar on the analysis of the
polymorphism of the serotonin transporter SLC6A4 (Gly56Ala) and Tryptophan Hidroxylase-
2 genes (Arg441His) as well as environmental factors in ASD, concluded that environmental
factors have a considerable influence on the incidence ASD. This study shows that prenatal
environmental factors include the use of drugs / herbs, maternal diseases affect the occurrence
of ASD. Likewise, perinatal factors include premature, LBW, obstetric and postnatal
complications including jaundice, convulsions, head trauma, and non-exclusive breastfeeding
have an effect on the occurrence of ASD.
ASD has an impact on children and families. The impact on children includes poor
school performance, disruption of socialization, low employment status, increased risk of
accidents. The impact on the family is the emergence of severe stress and depression in
parents or caregivers, thus affecting family harmony. This disorder, therefore, is chronic
which requires energy and costs that are not easily to handle and the expected results of
treatment cannot be guaranteed (Griadhi et al., 2013).
Seeing the tendency of increasing prevalence of autism in various parts of the world
from year to year and unclear data on the prevalence of autism in Makassar, this study aims to
explain the prevalence of Autism Spectrum Disoder in Makassar City and continued with
identification of prenatal (maternal age, hyperemesis gravidarum, antenatal hemorrhage,
PROM), intranatal (premature, LBW, asphyxia, birth trauma), and post natal (neonatal
jaundice, convulsions, exclusive breastfeeding, DHA and AA formula milk) environmental
factors as a significant factor in the incidence of ASD.

MATERIALS AND METHODS

Study Design and Variables
This study is a case control study. The variables consisted of: independent variables (maternal
age, hyperemesis gravidarum, antenatal bleeding, premature rupture of membranes,

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prematurity, LBW, neonatal asphyxia, delivery trauma, neonatal jaundice, seizures, exclusive
breastfeeding, formula milk containing DHA and AA, formula milk with no DHA and AA),
dependent variable (ASD in children), intermediate variables (pathomechanism of ASD),
random variables (genetic, age, and sex), control variables (congenital abnormalities and
neurological abnormalities), and moderator variables (immune deficiency).

Study Setting
This study was conducted in PAUD (Early Age Child Education) and Puskesmas in
Biringkanaya, Manggala, Panakukang, Tamalate, and Rappocini sub-district in Makassar city
from February to June 2018.

Population and Sample

The target population is all children aged 18 months - 6 years in the city of Makassar
which is recorded in the data of the Badan Pusat Statistik Kota Makassar 2017. The
population of the children sampled in this study is in the age range of 18 months to 6 years. At
the age of 18 months the earliest age of ASD assessment can be detected, while the age of 6
years because of that age is the target age of PAUD and kindergarten children who are the
target in this study.

Method of Data Collection

Every child who entered the research subject was given a questionnaire filled by
parents and then data was recorded in the form of: name, age, gender, telephone number,
weight, height and BMI. History taking, physical and neurology and developmental disorders
examination of KPSP, Denver II and also M-CHAT R / F screening to assess ASD risk. If the
M-CHAT R / F scoring is in the high risk category, then use DSM-V for ASD diagnostics, and
CARS to determine the severity of ASD. Collecting data through questionnaires, namely
environmental factors as risk factors, including: prenatal factors (maternal age during
pregnancy, hyperemesis gravidarum, history of antenatal bleeding, premature rupture of
membranes, history of medication consumed by the mother), perinatal factors (LBW,
gestational age of birth, history of neonatal asphyxia, history of delivery trauma), postnatal
factors (history of neonatal jaundice, history of seizures, history of exclusive breastfeeding,
and formula milk consumption).

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Data analysis
All data obtained from the examination of developmental disturbances and
questionnaires are grouped into ASD and non ASD children, then the risk factors are analyzed
using appropriate statistical methods based on the type of data and its objectives: univariate,
bivariate and multivariate analysis.

RESULTS
This case control study was conducted to explain the prevalence of Autism Spectrum
Disoder in Makassar City and continued with the identification of prenatal (maternal age,
hyperemesis gravidarum, antenatal bleeding, PROM), intranatal (premature, LBW, asphyxia,
delivery trauma), and post natal (neonatal jaundice, seizures, exclusive breastfeeding, DHA
and AA formula milk) environmental factors as a significant factor in the incidence of ASD.
The study was conducted in PAUD (Early Age Child Education) and Puskesmas in
Biringkanaya, Manggala, Panakukang, Tamalate, and Rappocini sub-district in Makassar from
February to June 2018.
During the study period, it was found 1300 children aged 18 months to 6 years who
met criteria in 5 sub-districts of Makassar, as follow: Biringkanaya sub-district with 107
samples, Manggala sub-district with 165 samples, Panakukang sub-district with 336 samples,
Tamalate sub-district with 93 samples, and Rappocini sub-district 599 samples.
From all study samples (1300), there were 22 children who suffered Autism Spectrum
Disorders (ASD), while those who were not ASD are accounted in 1278 (98.31%). In the
ASD group there were 18 boys (81.82%) and 4 girls (18.18%). In the non-ASD group there
were 643 boys (50.31%) and 635 girls (49.69%). Age (years) of subjects in the ASD group
ranged from 3.20 to 6.90 years, mean values were 5.35 years, median 5.45 years, standard
deviations (SD) 1.00 years. The age (years) of subjects in the non ASD group had values
ranging from 1.50 to 6.80 years, the mean value was 3.45 years, median was 3.30 years.
Standard of deviation (SD) is 1.26 years (appendix Table 1).
The level of father education in the ASD group, namely the secondary level as much
as 2 (9.09%) and further education as many as 20 (90.91%) subjects. Whereas in the non ASD
group, the father's education level was the basic level of 292 (22.85%) subjects, intermediate
level 685 (53.60%) subjects and advanced levels of 301 (23.55%) subjects (appendix, Table
2).
Examination of subjects to diagnose Autism Spectrum Disorders in this study,
preceded by examination of Denver II developmental disorders, M-Chat-R / F examination to

5
determine high risk or low risk of ASD, DSM V and CARS examination to determine ASD
and not ASD. However, to guarantee the validity of measurements made by researchers, prior
to study, an inter-examiner validity test is carried out between the researcher and verifier
(child development specialist) using DSM V.
The relationship between exclusive breastfeeding and the incidence of Autism
Spectrum Disorders was analized using bivariate analysis. In children with a history of
exclusive breastfeeding there were 8 (0.9%) subjects in the ASD group and 924 (99.1%)
subjects in the non ASD group, whereas in children without a history of exclusive
breastfeeding there were 14 (3.8%) subjects in the ASD group and 354 (96.2%) subjects in the
non ASD group. The results of the analysis showed that there were significant differences in
the frequency of ASD children with exclusive breastfeeding compared to children without
exclusive breastfeeding with p = 0.000 (p <0.05) and OR 0.219 (95% CI 0.091-0.526) which
showed protective values. ASD was 0.219 times in children who received exclusive
breastfeeding (appendix, Table 3).
From the results of multiple logistic regression analysis showed the relationship of
environmental factors to ASD that only 1 variable was truly significant, exclusive
breastfeeding as a protective factor with p = 0.001 and OR 0.233 (95% CI 0.096 to 0.565).
Odds Ratio (OR) which is an Adjusted Odds Ratio (AOR), which means that children who
consume exclusive breastfeeding have a protective factor for ASD at 0.233 times compared to
children not exclusively breastfed. While birth trauma was not significant after logistic
regression analysis with p = 0.061 (appendix, Table 4).

DISCUSSION
This study showed that prenatal and intranatal environmental factors did not
significantly influence the incidence of ASD, whereas in the post natal environment factor,
exclusive breastfeeding had a significant effect on the incidence of ASD.
In the bivariate analysis it was found that there were no significant differences in
prenatal factors including mothers with high risk age, mothers with hyperemesis gravidarum,
mothers with a history of antenatal bleeding and mothers with a history of premature rupture
of the membrane between the Autism Spectrum Disorders group and the non-Autism
Spectrum Disorders group.
There are many other factors that influence the process of neurogenesis; the condition
of the baby who is affected by nutrition and different genetic susceptibility in each baby so
that the occurrence of neurogenesis will be different. This allows insignificant results from the

6
effect of the incidence of premature rupture of membranes on the incidence of Autism
Spectrum Disorders.
Perinatal factors studied in this study were preterm birth, LBW, neonatal asphyxia and
delivery trauma. Preterm birth is often associated with lack of nutrients and immature organs.
This condition causes the child to suffer infection easily. The occurrence of premature birth is
also influenced by the condition of the mother during pregnancy. Case control study by Zhang
et al (2010), showed that preterm birth less than 35 weeks had a significant effect on the
occurrence of autism with statistical analysis of each p value = 0.004 (OR: 4.9 95% CI: 1.57-
15, 32).
Another perinatal factor, neonatal asphyxia, was also reported to have a significant
effect on the incidence of ASD. The onset of asphyxia will trigger hypoxia in brain cells. This
hypoxia will cause damage to neuronal cells which in turn will trigger neurodevelopmental
disorders. Neuron cell damage that occurs is influenced by the duration of hypoxia.
In this study, there were significant differences in the frequency of ASD children with
neonatal asphyxia compared to children without neonatal asphyxia with p = 0.032 (p <0.05)
OR = 3.835 (95% CI 1,264-11,653). But after performing regression analysis in neonatal
asphyxia along with other factors, exclusive breastfeeding and birth trauma, it was concluded
that asphyxia did not have a significant effect on the incidence of ASD with p = 0.065.
Insignifincancy of asphyxia is not possible here because in this study the condition of
asphyxia was stated by the mother's report stating that her child was not crying immediately
and there was no known weight and duration of asphyxia so hypoxia was difficult to predict.
Delivery trauma is one of the perinatal factors associated with the incidence of Autism
Spectrum Disorders. The presence of delivery trauma that can trigger neurogenesis is when
there is cerebral hemorrhage that causes hypoxia which subsequently causes brain cell
damage. Delivery trauma that can cause this condition is cephal hematoma. Delivery trauma
can also be caused by the use of forceps or vacuum extraction during the delivery process.
In this study, it was found that there were significant differences in the frequency of
ASD children with birth trauma compared to children without delivery trauma with p value =
0.042 (p <0.05), OR = 4,428 (95% CI 1,263-15,522). However, if regression analysis after
birth trauma is carried out along with other factors, exclusive breastfeeding and asphyxia, it is
concluded that birth trauma does not have a significant effect on the incidence of ASD with a
p-value = 0.061.
Many postnatal factors that have been studied in relation to the incidence of autism
include respiratory distress in neonates, anemia in infants, neonatal infection, intracranial

7
hemorrhage and exclusive breastfeeding. In addition to birth trauma, this study also analyzed
neonatal jaundice, seizures, exclusive breastfeeding and the use of formula milk in
conjunction with the incidence of Autism Spectrum Disorders. Some literature states that
there is a relationship between neonatal jaundice and the incidence of ASD. Jaundice that
result from increased bilirubin I can cause neuronal cell damage because bilirubin I can pass
through the blood brain barrier and become toxic to the basal ganglia and cerebellum which
are important organs in the development of autism. Zhang et al (2010) study also showed that
neonatal jaundice had a significant effect on the incidence of autism with p = 0.005 (p <0.05).
Another post natal factor analyzed was a history of seizures. Seizures associated with
the incidence of ASD are long seizures with duration of more than 15 minutes or recurrent
seizures. The occurrence of long seizures will cause brain hypoxia resulting in damage to
neuronal cells that will interfere with the synaptogenesis process.
In addition to jaundice and febrile seizures, exclusive breastfeeding is also associated
with the incidence of ASD. It is generally stated that the lack of exclusive breastfeeding is
associated with an increase in the incidence of behavioral disorders. The results of this study
indicate that there are significant differences in the frequency of ASD children with exclusive
breastfeeding compared to children without exclusive breastfeeding with p = 0,000 (p <0.05)
OR = 0.219 (95% CI 0.091-0.526). After regression analysis in exclusive breastfeeding is
performed along with other factors, asphyxia and delivery trauma, it is concluded that
exclusive breastfeeding does have a significant effect on the incidence of ASD with p = 0.001.
This study is in line with research conducted by Maddeppungeng (2014), in Makassar
with a case control design showed that there was a significant difference in the frequency of
children who were not exclusively breastfed between the ASD group and normal children
with p = 0.001. It can be concluded that exclusive breastfeeding will provide a protective
effect on the incidence of ASD.
Breast milk which contains DHA and AA, components of cell membranes including in
the brain. In addition, by breastfeeding, an emotional connection between mother and child is
formed through contact between the two. This contact is one of the stimulation processes.
Currently formula milk has been packed with a composition containing DHA and AA. This
study also assessed formula feeding in the incidence of ASD and concluded that there were no
significant differences in the frequency of ASD children who consumed formula milk
containing DHA and AA compared to children who consumed formula milk without
containing DHA and AA with p-value = 1,000 (p> 0, 05).

8
 One of the differences between breastfeeding and non-breastfeeding (formula milk) is
contact which becomes stimulation for the child. The more often the child is stimulated, the
more it will develop children's cognitive development. Stimulation of the environment is
different between each child. This possibility is a bias so that the results of the analysis are not
significant in formula milk feeding. In addition, other postnatal environmental factors can also
have an influence on a child's cognitive development.
It is generally stated that the incidence of Autism Spectrum Disorder is associated with
effects from genetics and the environment. Genetics and the environment together influence a
person's neurobehavioral changes. From the environmental factors involved, to date, there are
many involvements of percentages which cannot be ascertained. Some of the studies
mentioned above, in addition to analyze environmental factors, also studied their association
with genetic factors through relationships with relatives who suffer ASD. The difference in
results between this study and previous study can be caused by population, sampling time,
sampling place and different sampling methods.

CONCLUSION AND RECOMMENDATION

This study concluded that the prevalence of Autism Spectrum Disorders (ASD) in
Makassar was 1.69%. Prenatal and intranatal environmental factors did not significantly
influence the incidence of ASD, whereas in the post natal environment factor, exclusive
breastfeeding had a significant effect on the incidence of ASD with p = 0.001 (p <0.05).
Exclusive breastfeeding provides a protective value of 0.233 on the incidence of ASD
compared to normal children. The more interaction of environmental factors, the greater the
chance of ASD occurrence. Researchers suggest that further study should be conducted on
other causes as other pathomechanisms of ASD. Further study is needed regarding other
environmental factors that play a role as risk factors for ASD events.

9
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Adamsen D et al. (2010). Autism Associated with low 5-Hydroxyindolacetic Acid in CSF and
the heterozygousslc6a4 gene Gly56Ala Plus 5-HTTLPR L/L Promoter Variants.
Genet. Metab.
Griadhi M.O.R dkk. (2013). Diagnosis dan Penatalaksanaan Autisme. (Tesis). Denpasar:
Universitas Udayana.
Guinchat V et al. (2012). Pre-, Peri- and Neonatal Risk Factors for Autism. 287-300.
Maddeppungeng M. (2014). Analisis Polimorfisme Gen Serotonin Transporter SLC6A4
(Gly56Ala) dan Tryptophan Hidroxylase-2 (Arg441His) serta Faktor-Faktor
Lingkungan pada Autism Spectrum Disoders. (Disertasi). Makassar: Universitas
Hasanuddin.
Prasad H.C et al. (2009). Enhanced Activity of Human Serotonin Transporter Variants
Associated with Autism. Phil. Trans. R. Soc. B. 364: 163-173.
Pratiwi R.A & Dieny F.F. (2014). Hubungan Skor Frekuensi Diet Bebas Gluten Bebas Casein
dengan Skor Perilaku Autis. (Tesis). Semarang: Universitas Diponegoro.
Ratajczak H.V. (2011). Theoretical Aspects of Autism: Causes-A review. Journal of
Immunotoxicology. 8(1): 68-79.
Rice C.E. (2011). The Changing Prevalence of the Autistis Spectrum Disorders. Available
from www.aafp.org›Journals›afp. 83(5): 1-3.
Tchaconas A et al. (2013). Autism Spectrum Disorders : a Pediatric Overview and Update.
Curr Opin Pediatr. 25(1): 130-44.
Zafeiriou et al. (2009). The Serotonergic System: Its Role in Pathogenesis and Early
Developmental Treatment of Autism. Current Neuropharmacology. 7: 150-157.
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Autism and Developmental Disorders. NCBI.

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APPENDIX

Table 1. Characteristics of Study Subjects

Group
Variable ASD Non-ASD
22(1,69%) 1278(98,31%)
15 Speech delay
1261 Normal
Gender
Boy 18(81,82%) 643(50,31%)
Girl 4(18,18%) 635(49,69%)

Age (year)
Mean 5,35 3,45
Median 5,45 3,30
Standard Deviation (SD) 1,00 1,26
Range 3,20-6,90 1,50-6,80

Nutritional State
Poor 0(0%) 52(4,07%)
Underweight 2 (9,09%) 210(16,43%)
Good 18(81,82%) 950(74,34%)
Overweight 2(9,09%) 38(2,97%)
Obesity 0(0%) 28(2,19%)

Relationship with Caregiver

Mother 12(54,55%) 1144(89,52%)
Child’s Caregiver 4(18,18%) 40(3,13%)
Family 6(27,27%) 94(7,35%)

Caregiver’s Level of Education

None 0(0%) 3(0,24%)
Elementary school 0(0%) 358 (28,01%)
Junior high school 1(4,55%) 682(53,36%)
Senior high school 21(95,45%) 235(18,39%)

History of Allergic
Yes 12(54,55%) 110(8,61%)
None 10(45,45%) 1168(91,39%)

Digestion Disturbance
Diarrhea 6(27,27%) 43(3,36%)
Constipation 6(27,27%) 7(0,55%)
None 10(45,46%) 1228(96,09%)

Age of Electronic Exposure (month)

Mean 14,363 18,446
Median 12 14,5
Standard of Deviation (SD) 12,112 10,671
Range 1,00-48,00 1,00-60,00

Duration of Electronic Exposure

< 2 hours 5(22,73%) 925(72,38%)
> 2 hours 17(77,27%) 353(27,62%)

History of Developmental Disorder in

Family
Yes 10(45,45%) 31(2,43%)
None 12(54,55%) 1247(97,57%)

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Table 2. Characteristics of Parents’ Study Subjects

Group
Variable ASD Non-ASD
22(1,69%) 1278(98,31%)

Father’s Level of Education

None 0(0%) 0(0%)
Elementary school 0(0%) 292(22,85%)
Junior high school 2(9,09%) 685(53,60%)
Senior high school 20(90,91%) 301(23,55%)

Mother’s Level of Education

None 0(0%) 3(0,24%)
Elementary school 0()%) 358(28,01%)
Junior high school 1(4,55%) 682(53,37%)
Senior high school 21(95,45%) 235(18,38%)

Sosio-Economy State
Low 0(0%) 510(39,91%)
Intermediate 0(0%) 355(27,78%)
High 1(4,55%) 214(16,74%)
Very High 21(95,45%) tres

Stress in Pregnancy
Yes 9(40,91%) 94(7,35%)
None 13(59,09%) 1184(92,65%)

Mode of Delivery
Spontaneous 15(68,18%) 1063(83,18%)
Caesarean Section 7(31,82%) 215(16,82%)

Table 3. The relationship between history of exclusive breastfeeding and incidence of Autism Spectrum

Disorders (ASD)
Group
Breastfeeding Total
ASD Non-ASD
Exclusive Breast Milk 8 (0,9%) 924(99,1%) 932(100%)
Non-Exclusive Breast Milk 14 (3,8%) 354(96,2%) 368(100%)
Total 22(1,7%) 1278(98,3%) 1300(100%)
X2 Chi-Square = 13,763 p = 0,000 (p<0,05) OR = 0,219 (95% CI 0,091-0,526)

Table 4. Results of Risk Factor Logistic Double Regression Analysis on Autism Spectrum Disorders

No Variable b S.E. df Sig Exp(B) 95% CI for EXP(B)

1 Exclusive Breast Milk -1,455 0,451 1 0,001 0,233 0,096 – 0,565
2 Birth delivery 1,221 0,651 1 0,061 3,390 0,946 –12,151
3 Constanta -3,120 1,033 1 0,003 0,044 -
b : Regression coeficient S.E.: Standard of error Exp (B) : Adjusted Odds Ratio

12