研究背景：過去研究指出懷孕期間暴露空氣污染物會促使全身性的發炎反應，進而使胎兒中樞神經發展受損。根據近期文獻的回顧，產前與產後空氣污染暴露造成兒童發展障礙的風險仍未有充分的證據支持，仍有更進一步探討的空間。

研究目的：評估母親懷孕期間、孩童出生當月、與出生後一年間之空氣污染物暴露，對胎兒日後罹患發展障礙（包含泛自閉症）風險的影響並探討其性別差異。

研究方法：本研究為回溯性的世代研究，使用2004到2011年之衛生福利部健保資料庫臺灣婦幼資料庫，選出該期間出生的新生兒，並追蹤至2017年，利用健保就醫診斷資料以ICD-9-CM篩選出罹患發展障礙兒童(ICD-9-CM: 299、312.81、312.89、312.9、313-315、317-319、783.42、V79.8和V79.9)以及泛自閉症兒童(ICD-9-CM : 299.0、299.8、299.9)，連結母親懷孕期居住地之空氣監測站資料(包括：CO、NO2、SO2、PM10、PM2.5、和O3)，以球型經校正的克利金模式推估各鄉鎮兒童於胎兒時期、出生當月與出生後一年各環境空氣污染物之暴露量，以Cox比例風險模式評估空氣污染物對孩童罹病的風險，並探討其性別差異。

研究結果：研究族群共1,466,166位新生兒，其中154,814位被診斷患有發展障礙，有16,610位被診斷患有泛自閉症。在全孕期和產後一年，每增加100 ppb的CO暴露，增加1.023~1.083倍的發展障礙風險，以及1.062~1.124倍的泛自閉症風險；每增加10 ppb的NO2暴露，增加1.026~1.296倍的發展障礙風險，以及1.145~1.488倍的泛自閉症風險。PM10、PM2.5、SO2及O3暴露未顯著增加罹患發展障礙或泛自閉症的風險，風險比值為0.661~0.963倍。暴露於CO與NO2，男童患有發展障礙和泛自閉症的風險皆高於女童。發展障礙與特定空氣污染物之間存在性別的修飾作用，像是CO和NO2。

結論：本研究發現懷孕時期與產後一年暴露CO及NO2，會增加日後孩童於早年發展障礙和泛自閉症的風險，然而在PM10、PM2.5、SO2及O3暴露，並未發現同樣增加的風險。性別是CO與發展障礙之間的修飾因子。

Background: Previous studies indicate that exposure to air pollutants during pregnancy is correlated with systemic inflammatory response, which affects the development of the central nervous system in fetus. However, recent literature reviews found that there is no sufficient evidence supporting an increased risk of developmental disability (DD) associated with prenatal air pollution exposure.

Objective: To evaluate the effects of air pollution during pregnancy, the month of birth, and one year after birth on childhood DD, including autistic spectrum disorders (ASD), and assess their sexual differences.

Methods: We conducted a retrospective cohort study by retrieving all children who were born between 2004 and 2011 from the Maternal and Child Health Database in Taiwan and followed them to 2017. Using ICD-9-CM codes, we identified children with DD (ICD-9-CM: 299, 312.81, 312.89, 312.9, 313-315, 317-319, 783.42, V79.8 and V79.9) and ASD (ICD-9-CM: 299.0, 299.8 and 299.9). We linked them to data on carbon monoxide (CO), nitrogen dioxide (NO2), sulfur dioxide (SO2), particles with aerodynamic diameter less than 10 µm (PM10), PM2.5, and ozone (O3) obtained from air quality monitoring stations near the residencies of their mothers during pregnancy. The adjusted spherical spatial of Kriging model was used to predict air pollution exposure levels during the three-time windows studied at the town scale level. Cox proportional hazards (PH) models were used to evaluate the effects of air pollutants on the outcomes and assess the sexual differences.

Results: We identified 1,466,166 newborns in the database during the study period, and 154,814 of them were diagnosed with DD, including 16,610 with ASD. During gestation, the month of birth, and one year after birth, the adjusted hazard ratio (AHR) associated with each 100 ppb increase in CO was 1.023~1.083 for DD and 1.049~1.124 for ASD. The AHR associated with each 10 ppb increase in NO2 was 1.026~1.296 for DD and 1.084~1.488 for ASD. All those AHRs indicated increased risks except for that of NO2 during the month of birth with DD, which decreased to 0.900. The AHRs of DD and ASD did not indicate significantly increased risks associated with SO2, PM10, PM2.5, or O3, with a range of 0.661~0.963. The AHRs of DD and ASD associated with CO and NO2 were higher in boys than in girls. The effect modification by gender was present between DD and specific air pollutants, such as CO and NO2.

Conclusion: Our study found that CO and NO2 exposures during gestation and one year after birth were associated with DD and ASD in the early childhood, while exposures to SO2, PM10, PM2.5 and O3 were not. Gender is an effect modifier of the association between CO and DD.

Abdallah MW, Larsen N, Grove J, Norgaard-Pedersen B, Thorsen P, Mortensen EL, et al. 2013. Amniotic fluid inflammatory cytokines: Potential markers of immunologic dysfunction in autism spectrum disorders. The World Journal of Biological Psychiatry 14:528-538.
Allen JL, Liu X, Weston D, Prince L, Oberdörsteret G, Finkelstein JN et al. 2014. Developmental exposure to concentrated ambient ultrafine particulate matter air pollution in mice results in persistent and sex-dependent behavioral neurotoxicity and glial activation. Toxicol Sci 140(1):160-178.
Arndt TL, Stodgell CJ, Rodier PM. 2005. The teratology of autism. Int J Dev Neurosci 23:189-199.
Arnold AP, Breedlove SM. 1985. Organizational and activational effects of sex steroids on brain and behavior: a reanalysis. Horm Behav 19:469–498.
Auyeung B, Taylor K, Hackett G, Baron-Cohen S. 2010. Foetal testosterone and autistic traits in 18 to 24-month-old children. Mol Autism 1:11.
Bailey A, Palferman S, Heavey L, Le Couteur A. 1998. Autism: the phenotype in relatives. J Autism Dev Disord 28(5):369-92, PMID: 9813774.
Baio J. 2012. Prevalence of autism spectrum disorders: Autism and developmental disabilities monitoring network, 14 sites, united states, 2008. Morb Mortal Wkly Rep Surveill Summ 61:1-19.
Baron-Cohen S, Lombardo MV, Auyeung B, Ashwin E, Chakrabarti B, Knickmeyer R. 2011. Why are autism spectrum conditions more prevalent in males? PLoS Biol. 9:e1001081.
Becerra TA, Wilhelm M, Olsen J, Cockburn M, Ritz B. 2013. Ambient air pollution and autism in lLos aAngeles county, Ccalifornia. Environmental Health Perspectives 121:380-386.
Betts KS, Williams GM, Najman JM, Alati R. 2014. Maternal depressive, anxious, and stress symptoms during pregnancy predict internalizing problems in adolescence. Depress Anxiety. 31(1):9-18.
Bissonnette JM, Wickham WK. 1977. Placental diffusing capacity for carbon monoxide in unanesthetized guinea pigs. Respir Physiol 31:161–168.
Block ML, Elder A, Auten RL, Bilbo SD, Chen H, Chen JC, et al. 2012. The outdoor air pollution and brain health workshop. Neurotoxicology 33:972–84.
Bocci V, Borrelli E, Travagli V, Zanardi I. 2009. The ozone paradox: ozone is a strong oxidant as well as a medical drug. Med Res Rev 29(4):646–682.
Bolton JL, Marinero S, Hassanzadeh T, Natesan D, Le D, Belliveau C, Mason, S.N, et al. 2017. Gestational exposure to air pollution alters cortical volume, microglial morphology, and microglia-neuron interactions in a sex-specific manner. Front. Synaptic Neurosci 9:10.
Bouras N. 2011. Mental health problems and related issues for people with developmental and intellectual disability. Curr. Opin. Psychiatry 24(5):365-366.
Boyle CA, Boulet S, Schieve LA, Cohen RA, Blumberg SJ, Yeargin-Allsopp M, et al. 2011. Trends in the prevalence of developmental disabilities in us children, 1997-2008. Pediatrics 127:1034-1042.
Boyle CA, Decouflé P, Yeargin-Allsopp M. 1994. Prevalence and health impact of developmental disabilities in US children. Pediatrics 93(3):399-403.
Campbell A, Oldham M, Becaria A, Bondy SC, Meacher D, Sioutas C et al. 2005. Particulate matter in polluted air may increase biomarkers of inflammation in mouse brain. Neurotoxicology 26(1):133-40.
Carlson BM. 2008. Human Embryology and Developmental Biology, 4th St. Louis, MO: Elsevier-Health Sciences Division.
Centers for Disease Control and Prevention. 2008. Update on overall prevalence of major birth defects–Atlanta, Georgia, 1978-2005. MMWR Morb Mortal Wkly Rep 57(1):1-5.
Chen LJ, Chiou JY, Huang JY, Su PH, Chen JY. 2019. Birth defects in Taiwan: A 10-year nationwide population-based, cohort study. Journal of the Formosan Medical Association 119(1):553-559.
Chien IC, Lin CH, Chou YJ, Chou P. 2011. Prevalence and incidence of autism spectrum disorders among national health insurance enrollees in Ttaiwan from 1996 to 2005. Journal of child neurology 26:830-834.
Church JS, Tijerina PB, Emerson FJ, Coburn MA, Blum JL, Zelikoff JT, et al. 2018. Mar. Perinatal exposure to concentrated ambient particulates results in autism-like behavioral deficits in adult mice. Neurotoxicology 65:231e240.
Croen LA, Grether JK, Hoogstrate J, Selvin S. 2002. The changing prevalence of autism in California. J Autism Dev Disord 32(3):207-15.
Croonenberghs J, Wauters A, Devreese K, Verkerk R, Scharpe S, Bosmans E, et al. 2002. Increased serum albumin, γ globulin, immunoglobulin IigGg, and iIgGg2 and igg4 in autism. Psychological Medicine 32.
Currie J, Neidell M, Schmieder JF. 2009. Air pollution and infant health: Lessons from New Jersey. J Health Econ 28(3):688-703.
Dawson S, Glasson EJ, Dixon G, Bower C, et al. 2009. Birth defects in children with autism spectrum disorders: a population-based, nested case-control study. Am J Epidemiol 169(11):1296-303.
De Graaf-Peters VB, Hadders-Algra M. 2006. Ontogeny of the human central nervous system: What is happening when? Early Human Development 82:257-266.
De Vries G, Simerley RB. 2002. Anatomy, development and function of sexually dimorphic neural circuits in the mammalian brain. Hormones, Brain and Behavior 4:137-191.
Des Noyers Hurley A. 1996. Psychiatric disorders in children and adolescents with mental retardation and developmental disabilities. Curr Opin Pediatr 8(4):361-365.
Dexter SC, Pinar H, Malee MP, Hogan J, Carpenter MW, Vohr BR. 2000. Outcome of very low birth weight infants with histopathologic chorioamnionitis. Obstetrics and Gynecology 96:172-177.
Dix-Cooper L, Eskenazi B, Romero C, Balmes J, Smith KR. 2012. Neurodevelopmental performance among school age children in rural Guatemala is associated with prenatal and postnatal exposure to carbon monoxide, a marker for exposure to woodsmoke. Neurotoxicology 33(2):246–254.
Dodds L, Fell DB, Shea S, Armson BA, Allen AC, Bryson S. 2011. The role of prenatal, obstetric and neonatal factors in the development of autism. Journal of autism and developmental disorders 41:891-902.
Eapen V. 2014. Developmental and mental health disorders: two sides of the same coin. Asian J Psychiatr 8:7-11.
Flashner BM, Russo ME, Boileau JE, Leong DW, Gallicano GI. 2013. Epigenetic factors and autism spectrum disorders. Neuromolecular Med 15:339-350.
Folstein S, Rutter MRutter SFaM. 1977. Genetic influences and infantile autism. Nature 265:726 -728.
Fombonne E. 2003. Epidemiological surveys of autism and other pervasive developmental disorders: an update. J Autism Dev Disord 33(4):365-82.
Fombonne E. 2005. The changing epidemiology of autism. Journal of Applied Research in Intellectual Disabilities 18(4):281-294.
Fombonne E. 2008. Is autism getting commoner. Br J Psychiatry 193(1):59.
Fombonne E. 2009. Epidemiology of pervasive developmental disorders. Pediatric Research 65(6):591-598.
Frosini M, Contartese A, Zanardi I, Travagli V, Bocci V. 2012. Selective ozone concentrations may reduce the ischemic damage after a stroke. Free Radic. Res 46, 612–618.
Geschwind DH. 2011. Genetics of autism spectrum disorders. Trends Cogn Sci 15(9):409-416.
Gong T, Almqvist C, Bölte S, et al. 2014. Exposure to air pollution Ffrom traffic and neurodevelopmental disorders in Swedish twins. Twin Res Hum Genet. 17(6):553–562.
Goodrich AJ, Volk HE, Tancredi DJ, McConnell R, Lurmann FW, Hansen RL, et al. 2018. Joint effects of prenatal air pollutant exposure and maternal folic acid supplementation on risk of autism spectrum disorder. Autism Res 11(1), 69e80.
Grandjean P, Landrigan PJ. 2006. Developmental neurotoxicity of industrial chemicals. Lancet 368:2167–78.
Greingor JL, Tosi JM, Ruhlmann S, Aussedat M. 2001. Acute carbon monoxide intoxication during pregnancy. One case report and review of the literature. Emerg Med J 18:399–401.
Gressens P. 2000. Mechanisms and disturbances of neuronal migration. Pediatric Research 48:725-730.
Gupta RK, Hasan KM, Trivedi R, Pradhan M, Das V, Parikh NA, et al. 2005. Diffusion tensor imaging of the developing human cerebrum. Journal of Neuroscience Research 81:172-178.
Gürkan G, Sayin M, Kizmazoglu C, Erdogan MA, Yigitturk G, Yilmaz HE et al. 2020. Evaluation of the neuroprotective effects of ozone in an experimental spine injury model. Journal of Neurosurgery: Spine 1:1-9.
Guxens M, Garcia-Esteban R, Giorgis-Allemand L, Forns J, Badaloni C, Ballester F et al. 2014. Air pollution during pregnancy and childhood cognitive and psychomotor development: six European birth cohorts. Epidemiology 25(5):636-47.
Guxens M, Ghassabian A, Gong T, Garcia-Esteban R, Porta D, Giorgis-Allemand L, et al. 2016. Air Pollution Exposure during Pregnancy and Childhood Autistic Traits in Four European Population-Based Cohort Studies: The ESCAPE Project. Environ Health Perspect 124(1):133–140.
Hallmayer J, Cleveland S, Torres A, Phillips J, Cohen B, Torigoe T, et al. 2011. Genetic heritability and shared environmental factors among twin pairs with autism. Arch Gen Psychiatry 68(11):1095-1102.
Hansen CA, Barnett AG, Pritchard G. 2008. The effect of ambient air pollution during early pregnancy on fetal ultrasonic measurements during mid-pregnancy. Environ Health Perspect 116(3):362-9.
Harris MH, Gold DR, Rifas-Shiman SL, Melly SJ, Zanobetti A, Coull BA, et al. 2015. Prenatal and childhood traffic-related pollution exposure and childhood cognition in the project viva cohort (Massachusetts, USA). Environ Health Perspect 123(10):1072-8.
Helle Raun Andersen JBN, Philippe Grandjean. 2000. Toxicologic evidence of developmental neurotoxicity of environmental chemicals. Toxicology 144:121-127.
Holm VA. 1989. Developmental Disabilities: Delivery of Medical Care for Children and Adults. JAMA 262(20):2935–2936.
Hsu SW, Chiang PH, Lin LP, Lin JD, Hsu SW, Chiang PH, Lin LP, Lin JD. 2012. Disparity in autism spectrum disorder prevalence among Taiwan national health insurance enrollees: Age, gender and urbanization effects. Research in Autism Spectrum Disorders 6:836-841.
Hsu YH, Tsai WC, Kung PT. 2013. Health examination utilization in the visually disabled population in Taiwan: a nationwide population-based study. BMC Health Serv Res 13:509.
Isadore LR, Allen CCI. Leslie Rubin ACC. 1989. Developmental disabilities delivery of medical care for children and adults:Philadelphia, Pa, Lea and Febiger.
Jo H, Eckel SP, Chen JC, Cockburn M, Martinez MP, Chow T, et al. 2019. Gestational diabetes mellitus, prenatal air pollution exposure, and autism spectrum disorder. Environ Int 133(Pt A):105110.
Jones KL, Croen LA, Yoshida CK, Heuer L, Hansen R, Zerbo O, et al. 2016. Autism with intellectual disability is associated with increased levels of maternal cytokines and chemokines during gestation. Molecular psychiatry:1-7.
Jung CR, Lin YT, Hwang BF. 2013. Air pollution and newly diagnostic autism spectrum disorders: A population-based cohort study in Taiwan. PloS One 8(9):e75510.
Kalkbrenner AE, Schmidt RJ, Penlesky AC. 2014. Environmental chemical exposures and autism spectrum disorders: A review of the epidemiological evidence. Current problems in pediatric and adolescent health care 44:277-318.
Kalkbrenner AE, Windham GC, Serre ML, Akita Y, Wang X, Hoffman K, et al. 2015. Particulate matter exposure, prenatal and postnatal windows of susceptibility, and autism spectrum disorders. Epidemiology 26(1):30-42.
Karimi P, Kamali E, Mousavi SM, Karahmadi M. 2017. Environmental factors influencing the risk of autism. Journal of research in medical sciences: the official journal of Isfahan University of Medical Sciences 22:27.
Kaye JA, del Mar Melero-Montes M, Jick HJames A Kaye MdMM-M, and Hershel Jick. 2001. Mumps, measles, and rubella vaccine and the incidence of autism recorded by general practitioners: A time trend analysis. Bmj 302:460.
Kelly FJ. 2003. Oxidative stress: Its role in air pollution and adverse health effects. Occupational and Environmental Medicine 60:612-616.
Kerin T, Volk H, Li W, Lurmann F, Eckel S, McConnell R, et al. 2018. Association Between Air Pollution Exposure, Cognitive and Adaptive Function, and ASD Severity Among Children with Autism Spectrum Disorder. J Autism Dev Disord 48(1):137-150.
Kim E, Park H, Hong YC, Ha M, Kim Y, Kim BN, Kim Y, et al. 2014. Prenatal exposure to PM10 and NO2 and children’s neurodevelopment from birth to 24 months of age: mothers and Children’s Environmental Health (MOCEH)study. Sci Total Environ 481:439–445.
Knickmeyer R, Baron-Cohen S, Raggatt P, Taylor K. 2005. Foetal testosterone, social cognition, and restricted interests in children. J Child Psychol Psych 46:198–210.
Kuo HT, Muo CH, Chang YT, Lin CK. 2015. Change in prevalence status for children with developmental delay in Taiwan: a nationwide population-based retrospective study. Neuropsychiatr Dis Treat 11:1541-7.
Lai DC, Tseng YC, Guo HR. 2011. Gender and geographic differences in developmental delays among young children: Analysis of the data from the national registry in Taiwan. Res Dev Disabil 32(1):63-9.
Lai DC, Tseng YC, Guo HR. 2013. Trends in the prevalence of childhood disability: analysis of data from the national disability registry of Taiwan, 2000-2011. Res Dev Disabil 34(11):3766-72.
Lai DC, Tseng YC, Guo HR. 2018. Characteristics of young children with developmental delays and their trends over 14 years in Taiwan: a population-based nationwide study. BMJ Open 8(5):e020994.
Lai DC, Tseng YC, Hou YM, Guo HR. 2012a. Gender and geographic differences in the prevalence of autism spectrum disorders in children: Analysis of data from the national disability registry of Taiwan. Res Dev Disabil 33(3):909-15.
Lai DC, Tseng YC, Hou YM, Guo HR. 2012b. Gender and geographic differences in the prevalence of intellectual disability in children: Analysis of data from the national disability registry of tTaiwan. Research in developmental disabilities 33:2301-2307.
Lapchak PA, Araujo DM, Song D, Zivin JA. 2001. Neuroprotection by the selective cyclooxygenase-2 inhibitor SC-236 results in improvements in behavioral deficits induced by reversible spinal cord ischemia. Stroke 32(5):1220–1225.
LaSalle JM. 2013. Epigenomic strategies at the interface of genetic and environmental risk factors for autism. J Hum Genet 58(7):396-401.
Lertxundi A, Andiarena A, Martínez MD, Ayerdi M, Murcia M, Estarlich M, Guxens M, et al. 2019. Prenatal exposure to PM2.5 and NO2 and sex-dependent infant cognitive and motor development. Environ Res. 174:114-121.
Lertxundi A, Baccini M, Lertxundi N, Fano E, Aranbarri A, Martínez MD et al. 2015. Exposure to fine particle matter, nitrogen dioxide and benzene during pregnancy and cognitive and psychomotor developments in children at 15 months of age. Environ Int 80:33-40.
Liao D, Peuquet DJ, Duan Y, Whitsel EA, Dou J, Smith RL, et al. 2006. GISis approaches for the estimation of residential-level ambient pm concentrations. Environmental Health Perspectives 114:1374-1380.
Lin CC, Yang SK, Lin KC, Ho WC, Hsieh WS, Shu BC et al. 2014. Multilevel analysis of air pollution and early childhood neurobehavioral development. Int J Environ Res Public Health 11(7):6827-41.
Lin CM, Lee PC, Teng SW, Lu TH, Mao IF, Li CY. 2004. Validation of the taiwan birth registry using obstetric records. Journal of the Formosan Medical Association 103:297-301.
Lin JD, Hung WJ, Lin LP, Lai CILin J-D, Hung W-J, Lin L-P, Lai C-I. 2011. Utilization and expenditure of hospital admission in patients with autism spectrum disorder: National health insurance claims database analysis. Research in Autism Spectrum Disorders 5:1138-1142.
Liu CY, Hung YT, Chuang YL, Chen YJ, Weng WS, Liu JS, et al. 2006. Incorporating development stratification of Taiwan townships into sampling design of large scale health interview survey. J Health Management 4:1–22.
Lucchina L, Depino AM. 2014. Altered peripheral and central inflammatory responses in a mouse model of autism. Autism Research 7:273-289.
Lutchmaya S, Baron-Cohen S, Raggatt P. 2002. Foetal testosterone and eye contact in 12 month old infants. Infant Behav and Dev 25:327–335.
Lutchmaya S, Baron-Cohen S, Raggatt P. 2002. Foetal testosterone and vocabulary size in 18- and 24-month-old infants. Infant Behav and Dev 24:418–424.
Lyall K, Croen L, Daniels J, Fallin MD, Ladd-Acosta C, Lee BK, et al. 2017. The changing epidemiology of autism spectrum disorders. Annu Rev Public Health 38:81-102, PMID: 28068486, https://doi.org/10.1146/annurev-publhealth-031816-044318.
Lyall K, Schmidt RJ, Hertz-Picciotto I. 2014. Maternal lifestyle and environmental risk factors for autism spectrum disorders. International journal of epidemiology 43(2):443-464.
Mage DT, Zali O, World Health Organization. Division of Environmental Health. ‎1992‎. Motor vehicle air pollution : public health impact and control measures edited by David Mage and Olivier Zali. World Health Organization. https://apps.who.int/iris/handle /10665/61927.
McCarthy MM. 2016. Sex differences in the developing brain as a source of inherent risk. Dialogues Clin. Neurosci. 18:361e372.
McGregor HP, Westcott K, Walker DW. 1998. The effect of prenatal exposure to carbon monoxide on breathing and growth of the newborn guinea pig. Pediatr Res 43:126–31.
Morales E, Julvez J, Torrent M, de Cid R, Guxens M, Bustamante M et al. 2009. Association of early-life exposure to household gas appliances and indoor nitrogen dioxide with cognition and attention behavior in preschoolers. Am J Epidemiol 169(11):1327-36, PMID: 19395695, https://doi.org/10.1093/aje/kwp067.
Mrzljak L, Uylings HBM, Kostovic I, Eden CGv. 1992. Prenatal development of neurons in the human prefrontal cortex. Ii. A quantitative golgi study. Journal of Comparative Neurology 316:485-496.
National Health Insurance Administration, Ministry of Health and Welfare, Taiwan, R.O.C. 2018. National Health Insurance Annual Statistical Report 2018. Available: https://www.nhi.gov.tw/DL.aspx?sitessn=293&u=LzAwMS9VcGxvYWQvMjkzL3JlbGZpbGUvMC8xMjg1NTkvMTA35bm05YWo5rCR5YGl5bq35L%2bd6Zqq57Wx6KiILnBkZg%3d%3d&n=MTA35bm05YWo5rCR5YGl5bq35L%2bd6Zqq57Wx6KiILnBkZg%3d%3d&ico%20=.pdf
Nemmar A, Hoet PHM, Vanquickenborne B, Dinsdale D, Thomeer M, Hoylaerts MF, et al. 2002. Passage of inhaled particles into the blood circulation
Newschaffer CJ, Croen LA, Daniels J, Giarelli E, Grether JK, Levy SE, et al. 2007. The epidemiology of autism spectrum disorders. Annu Rev Public Health 28:235-258.
Ondine S. von Ehrenstein HA, Myles Cockburn and Beate Ritzd. 2014. In utero exposure to toxic air pollutants and risk of childhood autism. Epidemiology 25:851-858.
Owen MJ, Craddock N, Jablensky A. 2007. The genetic deconstruction of psychosis. Schizophr Bull 33(4):905–911.
Pagalan L, Bickford C, Weikum W, Lanphear B, Brauer M, Lanphear N, et al. 2019. Association of Prenatal Exposure to Air Pollution With Autism Spectrum Disorder. JAMA Pediatr 173(1):86-92.
Pan WC, Wu CD, Chen MJ, Huang YT, Chen CJ, Su HJ, et al. 2016. Fine particle pollution, alanine transaminase, and liver cancer: A tTaiwanese prospective cohort study (reveal-hbv). Journal of the National Cancer Institute 108:djv341.
Perera F, Herbstman J. 2011. Prenatal environmental exposures, epigenetics, and disease. Reproductive toxicology 31(3):363-373.
Phoenix CH, Goy RW, Gerall AA, Young WC. 1959. Organizing action of prenatally administered testosterone propionate on the tissues mediating mating behavior in the female guinea pig. Endocrinology 65:369–382.
Polleux F, Lauder JM. 2004. Toward a developmental neurobiology of autism. Mental retardation and developmental disabilities research reviews 10:303-317.
Powell JE, Edwards A, Edwards M, Pandit BS, Sungum-Paliwal SR, Whitehouse WJE Powell AE, M Edwards, BS Pandit, SR Sungum-Paliwal, and W Whitehouse. 2000. Changes in the incidence of childhood autism and other autistic spectrum disorders in preschool children from two areas of the west midlands, uk. Developmental Medicine and Child Neurology 42:624-628.
Rakic P, Cameron RS, Komuro H. 1994. Recognition, adhesion, transmembrane signaling and cell motility in guided neuronal migration. Current Opinion in Neurobiology 4:63-69.
Raz R, Roberts AL, Lyall K, Hart JE, Just AC, Laden F, et al. 2015. Autism spectrum disorder and particulate matter air pollution before, during, and after pregnancy: A nested case-control analysis within the Nurses' Health Study IIi cohort. Environ Health Perspect 123:264-270.
Rice C. 2009. Prevalence of autism spectrum disorders–autism and developmental disabilities monitoring network, 14 sites, united state, 2002. Morb Mortal Wkly Rep Surveill Summ 56:12-28.
Rice D, Barone Jr S. 2000. Critical periods of vulnerability for the developing nervous system: evidence from humans and animal models. Environ Health Perspect 108(Suppl. 3):511–33.
Roberts AL, Lyall K, Hart JE, Laden F, Just AC, Bobb JF et al. 2013. Perinatal air pollutant exposures and autism spectrum disorder in the children of Nurses' Health Study II participants. Environmental health perspectives 121(8):978–984.
Robinson EB, Lichtenstein P, Anckarsäter H, Happé F, Ronald A. 2013. Proc Natl Acad Sci U S A 110(13):5258-62.
Rubin IL, Crocker AC. 1989. Developmental disabilities: Delivery of medical care for children and adults. Philadelphia: Lea & Febiger.
Rutter M. 1977. Genetic influences and infantile autism. Nature 265(5596):726-728.
Rutter M. 2005. Incidence of autism spectrum disorders: Changes over time and their meaning. Acta Paediatr 94(1):2-15.
Samuelsen GB, Larsen KB, Bogdanovic N, Laursen H, Græm N, Larsen JF, et al. 2003. The changing number of cells in the human fetal forebrain and its subdivisions: A stereological analysis. Cerebral Cortex 13:115-122.
Sandin S, Lichtenstein P, Kuja-Halkola R, Larsson H, Hultman CM, Reichenberg A. 2014. The familial risk of autism. Jama 311:1770-1777.
Sarnat HB, Flores-Sarnat L. 2004. Integrative classification of morphology and molecular genetics in central nervous system malformations. American Journal of Medical Genetics Part A 126A:386-392.
Sarnat HB, Nochlin D, Born DE. 1998. Neuronal nuclear antigen (neun): A marker of neuronal maturation in the early human fetal nervous system1. Brain and Development 20:88-94.
Sidman RL, Rakic P. 1973a. Neuronal migration, with special reference to developing human brain: A review. Brain Research 62:1-35.
Smeeth L, Cook C, Fombonne PE, Heavey L, Rodrigues LC, Smith PG, et al. 2004. Rate of first recorded diagnosis of autism and other pervasive developmental disorders in uUnited kKingdom general practice, 1988 to 2001. BMC Med 2:39.
Special Education Transmit Net 2019. Yearly bulletin of statistics for Special Education: Special Education students. https://www.set.edu.tw/actclass/fileshare/default.asp. Accessed 20.03.23.
Steffenburg S, Gillberg C, Hellgren L, Andersson L, Gillberg IC, Jakobsson G, et al. 1989. A twin study of autism in denmark, finland, iceland, norway and sweden. J Child Psychol Psychiatry 30(3):405-16.
Stübinger S, Sader R, Filippi A. 2006. The use of ozone in dentistry and maxillofacial surgery: a review. Quintessence Int. 37(5):353–359.
Suglia SF, Gryparis A, Wright RO, Schwartz J, Wright RJ. 2008. Association of black carbon with cognition among children in a prospective birth cohort study. Am J Epidemiol 167(3):280-6.
Sun X, Allison C, Matthews FE, Sharp SJ, Auyeung B, Baron-Cohen S, et al. 2013. Prevalence of autism in Mainland China, Hong Kong and Taiwan: A systematic review and meta-analysis. Molecular Autism.
Sun X, Allison C. 2010. A review of the prevalence of autism spectrum disorder in asia. Research in Autism Spectrum Disorders 4:156-167.
Szymanski L, Madow L, Mallory G et al. 1990. Report of the task force on psychiatric services to adult mentally retarded and developmentally disabled persons. Washington DC: American Psychiatric Association.
Tran NQV, Miyake K. 2017. Neurodevelopmental Disorders and Environmental Toxicants: Epigenetics as an Underlying Mechanism. Int J Genomics 2017:7526592.
US Environmental Protection Agency (US EPA). 2002. A Comprehensive Analysis of Biofuel Impacts on Exhaust Emissions. Available at https://cleanenergysolutions. org/fr/resources/comprehensive-analysis-biodiesel-impacts-exhaust-emissions [Accessed Dec 31, 2019]
US Environmental Protection Agency. 2012. Carbon monoxide. [Online]. Available at: http://www.epa.gov/airquality/carbonmonoxide/ [Accessed Dec 31, 2019].
Vassilev ZP, Robson MG, Klotz JB. 2001. Outdoor exposure to airborne polycyclic organic matter and adverse reproductive outcomes: a pilot study. Am J Ind Med. 40(3):255-62, PMID: 11598971.
Vasudevan P, Suri M. 2017. A clinical approach to developmental delay and intellectual disability. Clin Med (Lond) 17(6):558-561, PMID: 29196358, https://doi.org/10.7861/clinmedicine.17-6-558.
Vrijheid M, Martinez D, Aguilera I, Bustamante M, Ballester F, Estarlich M, et al. 2012. Indoor air pollution from gas cooking and infant neurodevelopment. Epidemiology 23:23–32.
Walters DM, Breysse PN, Wills-Karp M. 2001. Ambient urban baltimore particulate-induced airway hyperresponsiveness and inflammation in mice. American Journal of Respiratory and Critical Care Medicine 164:1438-1443.
Watanabe N, Kurita M, 2001. The masculinization of the fetus during pregnancy due to inhalation of diesel exhaust. Environ. Health Perspect 109(2):111-119.
Wegiel J, Kuchna I, Nowicki K, Imaki H, Wegiel J, Marchi E, et al. 2010. The neuropathology of autism: Defects of neurogenesis and neuronal migration, and dysplastic changes. Acta Neuropathologica 119:755-770.
Wei T, Chen C, Hou J, Xin W, Mori A. 2000. Nitric oxide induces oxidative stress and apoptosis in neuronal cells. Biochimica et Biophysica Acta (BBA) - Molecular Cell Research 1498:72-79.
Whitehouse AJ, Durkin K, Jaquet E, Ziatas K. 2009a. Friendship, loneliness and depression in adolescents with Asperger's syndrome. J. Adolesc 32(2):309-322.
Whitehouse AJ, Watt HJ, Line EA, Bishop DV. 2009b. Adult psychosocial outcomes of children with specific language impairment, pragmatic language impairment and autism. Int. J. Lang. Commun. Disord 44(4):511-528.
Yeargin-Allsopp M, Murphy CC, Oakley GP, Sikes RK. 1992. A multiple-source method for studying the prevalence of developmental disabilities in children: the Metropolitan Atlanta Developmental Disabilities Study. Pediatrics 89(4 Pt 1):624-30, PMID: 1372970.
Yorifuji T, Kashima S, Diez MH, Kado Y, Sanada S, Doi H. 2017. Prenatal exposure to outdoor air pollution and child behavioral problems at school age in Japan. Environ Int 99:192-198.
Zerbo O, Yoshida C, Grether JK, Water JVd, Ashwood P, Delorenze GN, et al. 2014. Neonatal cytokines and chemokines and risk of autism spectrum disorder: The eEarly mMarkers for aAutism (EMAema) study: A case-control study. Journal of Neuroinflammation 11:113.
Zhang J, Piantadosi CA. 1992. Mitochondrial oxidative stress after carbon monoxide hypoxia in the rat brain. Journal of Clinical Investigation 90:1193-1199.
王叔源。2016。環境空氣汙染暴露與自閉症障礙之風險。國立成功大學環境醫學研究所碩士論文，臺南市。取自https://hdl.handle.net/11296/343s2d
田聖芳。2006。台灣婦女產後照護之變遷—以北部地區為例。臺灣大學護理學研究所博士學位論文，臺北市。取自https://www-airitilibrarycom.er.lib.ncku.edu.tw/ ublication/alDetailedMesh1? ocID=U00012601200610451000#Citedliterature
阮語艷。2007。中部地區孕產婦對產後照顧（坐月子中心）需求之探討-以台中巿為例。中國醫藥大學醫務管理學系碩士班學位論文，臺中市。取自https://www-airitilibrary-com.er.lib.ncku.edu.tw/Publication/alDetailedMesh1?DocID=U0013-3007200711583900