Risk and protective environmental factors associated with autism spectrum disorder: Evidence-based principles and recommendations

Leonardo Emberti Gialloreti*, Luigi Mazzone, Arianna Benvenuto, Alessio Fasano, Alicia Garcia Alcon, Aletta Kraneveld, Romina Moavero, Raanan Raz, Maria Pia Riccio, Martina Siracusano, Ditza A. Zachor, Marina Marini, Paolo Curatolo

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

78 Scopus citations


Autism Spectrum Disorder (ASD) is a complex condition with early childhood onset, characterized by a set of common behavioral features. The etiology of ASD is not yet fully understood; however, it reflects the interaction between genetics and environment. While genetics is now a well-established risk factor, several data support a contribution of the environment as well. This paper summarizes the conclusions of a consensus conference focused on the potential pathogenetic role of environmental factors and on their interactions with genetics. Several environmental factors have been discussed in terms of ASD risk, namely advanced parental age, assisted reproductive technologies, nutritional factors, maternal infections and diseases, environmental chemicals and toxicants, and medications, as well as some other conditions. The analysis focused on their specific impact on three biologically relevant time windows for brain development: the periconception, prenatal, and early postnatal periods. Possible protective factors that might prevent or modify an ASD trajectory have been explored as well. Recommendations for clinicians to reduce ASD risk or its severity have been proposed. Developments in molecular biology and big data approaches, which are able to assess a large number of coexisting factors, are offering new opportunities to disentangle the gene–environment interplay that can lead to the development of ASD.

Original languageAmerican English
Article number217
JournalJournal of Clinical Medicine
Issue number2
StatePublished - 2019

Bibliographical note

Publisher Copyright:
© 2019 by the authors. Licensee MDPI, Basel, Switzerland.


  • Autism Spectrum Disorder
  • Environment
  • Genetics
  • Medications
  • Protective factors
  • Recommendations
  • Risk factors
  • Toxicants


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