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Prenatal exposure to air pollution and the development of autism spectrum disorder from birth to adolescence: A nationwide Danish cohort study

Lim, Youn Hee ; Lawlor, Cale LU ; Bergmann, Marie ; Zhang, Jiawei ; So, Rina ; Napolitano, George Maria LU ; Hevia-Ramos, Gonzalo ; Andersson Nystedt, Tanya LU orcid ; Pira, Kajsa LU orcid and Malmqvist, Ebba LU orcid , et al. (2026) In Environmental Epidemiology
Abstract
Background:
Prenatal exposure to ambient air pollution has been linked to autism spectrum disorder (ASD), but evidence from low-exposure settings such as Denmark remains limited.

Objective:
We aimed to examine the association between prenatal exposure to particulate matter with a diameter of ≤2.5 µm (PM2.5), black carbon (BC), and nitrogen dioxide (NO2) and ASD in children, and to identify the most susceptible groups.

Methods:
We included 850,361 children born in Denmark between 1990 and 2004 and followed them for ASD diagnoses in the Danish Patient Register until age 15 years. We assigned prenatal PM2.5, BC, and NO2 levels (Danish Eulerian Hemispheric Model/Urban Background Model) at the mother’s... (More)
Background:
Prenatal exposure to ambient air pollution has been linked to autism spectrum disorder (ASD), but evidence from low-exposure settings such as Denmark remains limited.

Objective:
We aimed to examine the association between prenatal exposure to particulate matter with a diameter of ≤2.5 µm (PM2.5), black carbon (BC), and nitrogen dioxide (NO2) and ASD in children, and to identify the most susceptible groups.

Methods:
We included 850,361 children born in Denmark between 1990 and 2004 and followed them for ASD diagnoses in the Danish Patient Register until age 15 years. We assigned prenatal PM2.5, BC, and NO2 levels (Danish Eulerian Hemispheric Model/Urban Background Model) at the mother’s residential address at delivery, and examined the association with ASD using logistic regression with a random intercept for municipality, including interaction terms to assess effect modification by sex, maternal age, smoking status, and socioeconomic status (SES).

Results:
An interquartile range increase in prenatal exposure to PM2.5, BC, and NO2 was associated with ASD (adjusted odds ratio; 95% confidence interval = 1.04; 1.00–1.07 per 2.8 µg/m3, 1.05; 1.03–1.08 per 0.3 µg/m3, and 1.15; 1.11–1.19 per 8 µg/m3, respectively). The association between BC and ASD persisted even after adjusting for PM2.5. Additionally, the associations between prenatal air pollution exposure and ASD were stronger among children born to older mothers.

Conclusion:
We found that prenatal exposure to air pollution was associated with ASD even at the relatively low exposure levels observed in Denmark, underscoring the importance of air pollution reduction for ASD prevention. The association with BC was independent of that with PM2.5, and children born to older mothers appeared to be particularly vulnerable. (Less)
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organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Environmental Epidemiology
publisher
Wolters Kluwer
external identifiers
  • pmid:41674801
  • scopus:105029762396
ISSN
2474-7882
DOI
10.1097/EE9.0000000000000462
language
English
LU publication?
yes
id
e1d03716-b777-4f6c-8729-2025bf3b5bc7
date added to LUP
2026-02-18 15:06:03
date last changed
2026-02-19 04:03:25
@article{e1d03716-b777-4f6c-8729-2025bf3b5bc7,
  abstract     = {{Background: <br/>Prenatal exposure to ambient air pollution has been linked to autism spectrum disorder (ASD), but evidence from low-exposure settings such as Denmark remains limited.<br/><br/>Objective: <br/>We aimed to examine the association between prenatal exposure to particulate matter with a diameter of ≤2.5 µm (PM2.5), black carbon (BC), and nitrogen dioxide (NO2) and ASD in children, and to identify the most susceptible groups.<br/><br/>Methods: <br/>We included 850,361 children born in Denmark between 1990 and 2004 and followed them for ASD diagnoses in the Danish Patient Register until age 15 years. We assigned prenatal PM2.5, BC, and NO2 levels (Danish Eulerian Hemispheric Model/Urban Background Model) at the mother’s residential address at delivery, and examined the association with ASD using logistic regression with a random intercept for municipality, including interaction terms to assess effect modification by sex, maternal age, smoking status, and socioeconomic status (SES).<br/><br/>Results: <br/>An interquartile range increase in prenatal exposure to PM2.5, BC, and NO2 was associated with ASD (adjusted odds ratio; 95% confidence interval = 1.04; 1.00–1.07 per 2.8 µg/m3, 1.05; 1.03–1.08 per 0.3 µg/m3, and 1.15; 1.11–1.19 per 8 µg/m3, respectively). The association between BC and ASD persisted even after adjusting for PM2.5. Additionally, the associations between prenatal air pollution exposure and ASD were stronger among children born to older mothers.<br/><br/>Conclusion: <br/>We found that prenatal exposure to air pollution was associated with ASD even at the relatively low exposure levels observed in Denmark, underscoring the importance of air pollution reduction for ASD prevention. The association with BC was independent of that with PM2.5, and children born to older mothers appeared to be particularly vulnerable.}},
  author       = {{Lim, Youn Hee and Lawlor, Cale and Bergmann, Marie and Zhang, Jiawei and So, Rina and Napolitano, George Maria and Hevia-Ramos, Gonzalo and Andersson Nystedt, Tanya and Pira, Kajsa and Malmqvist, Ebba and Oudin, Anna and Andersen, Zorana Jovanovic}},
  issn         = {{2474-7882}},
  language     = {{eng}},
  publisher    = {{Wolters Kluwer}},
  series       = {{Environmental Epidemiology}},
  title        = {{Prenatal exposure to air pollution and the development of autism spectrum disorder from birth to adolescence: A nationwide Danish cohort study}},
  url          = {{http://dx.doi.org/10.1097/EE9.0000000000000462}},
  doi          = {{10.1097/EE9.0000000000000462}},
  year         = {{2026}},
}