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In all the three studies, the outcome was defined as childhood autism. The two studies in which the outcome was defined as ��any ASD��[8, 10] also yielded contradictory findings. Finally, in a study including 72 cases with childhood autism, Asperger's and Tourette's syndrome, there was a positive association with smoking.[9] Ronald et?al.[8] 2010 England & Wales population-based twins born 1994�C1996 YES correlation r?=?0.03�C0.10 P?Selleckchem CB-839 1994�C1999 Retrospective, self-report: smoking? No/Yes but stopped/Yes Cases (n?=?72) remaining cohort (n?=?4?779) YES OR?=?2.09 (1.08�C4.03) Bilder et?al.[10] 2009 Utah, USA Population-based case-control study born 1994 Cases (n?=?132) controls* (n?=?13?200) NO OR?=?0.506 (0.222�C1.152) Maimburg et?al.[11] 2006 Denmark Population-based case�Ccontrol study born 1990�C1999 Cases (n?=?473) controls* (n?=?4?730) NO adjusted OR?=?0.9 (0.7�C1.4) Larsson et?al.[12] 2005 Denmark Population-based Ritipenem nested case�Ccontrol study born 1973�C1999 Cases (n?=?698) controls* (n?=?17?450) NO RR?=?1.06 (0.80�C1.39) Hultman et?al.[13] 2002 Sweden Population-based nested case�Ccontrol study born 1974�C1993 Cases (n?=?408) controlsa (n?=?2?040) YES adjusted OR?=?1.4 (1.1�C1.8) Table?1 reveals significant heterogeneity among study designs, which complicates the comparison of results between different studies. First, the previous epidemiological studies are limited by the size of the study groups, from as low as 72 to as high as 698 autism cases. Smaller sample sizes diminish statistical power to test the associations between smoking and ASD outcome. Second, data on smoking were collected either retrospectively, which increases the risk of maternal recall bias, or was ascertained at the beginning of the pregnancy, rather than throughout the pregnancy. Therefore, previous studies on smoking are limited to first trimester exposure. Third, the case www.selleckchem.com/products/BI6727-Volasertib.html definition for autistic disorders was relatively broad, including the whole ASD group or different subtypes of diagnoses. Thus, it is unclear whether the associations between maternal smoking and ASD differ by diagnostic subtype. According to the International Classification of Diseases, 10th Revision (ICD-10), childhood autism, Asperger's syndrome, and other pervasive developmental disorders/pervasive developmental disorder unspecified (PDD) belong to the broader category of pervasive developmental disorders.[14] This group is characterised by qualitative abnormalities in reciprocal social interactions and patterns of communication, and a restrictive, stereotyped, repetitive repertoire of interests and activities. Childhood autism, the most severe disorder of the three subtypes, is diagnosed based on impaired development in all three of these domains, with an onset by the age of three years.
