Prenatal Perinatal And Postnatal Factors Associated With Autism Spectrum Disorder Cases In Xuzhou China
Zenghua Yong1#, Yunlong Dou1#, Yuchen Gao1, Xuena Xu1, Yanli Xiao1, Hongjuan Zhu1, Shengli Li2, Baoqiang Yuan1
1Childrens Neurological Rehabilitation Center, The Affiliated Hospital of Xuzhou Medical University , The Affiliated Hospital of Xuzhou Medical University , , China
Contributions: Conception and design: Z Yong, Y Dou, B Yuan Administrative support: B Yuan Provision of study materials or patients: All authors Collection and assembly of data: X Xu, Y Xiao Data analysis and interpretation: Y Xiao, H Zhu, S Li Manuscript writing: All authors Final approval of manuscript: All authors.
#These authors contributed equally to this work.
Background: The aim of the present study was to explore the prenatal, perinatal, and postnatal risk factors in children with autism spectrum disorder from Xuzhou, China by comparing them with healthy children.
Methods: Children with ASD who received rehabilitation training at special education schools and rehabilitation institutions in Xuzhou were selected as the ASD group, and healthy children during the same period were selected as the healthy non-ASD group. A questionnaire based on the possible causes and susceptibility factors of ASD in children was issued and given to all children in this study.
This survey confirmed the high prevalence of prenatal, perinatal, and postnatal factors in children with ASD. Some of these factors may be effective entry points for the prevention and treatment of ASD.
Autism Adhd On The Rise
Experts are struggling to understand why autism is one of the fastest-growing developmental disorders in the United States, affecting 1 in every 44 8-year-old children. The incidence of ADHD is also rising, affecting 9.4% of children ages 2 to 17.
Both diseases likely stem from many different factors, so their true cause is poorly understood, says Dr. Zanotti.
None of the studies reviewed looked at environmental factors, maternal characteristics or genetic factors, which could heighten the risk for autism or ADHD.
We need more research to fully understand the effects of prolonged acetaminophen exposure on the baby during pregnancy, she notes.
Pregnancies Less Than A Year Apart
From the Study to Explore Early Development spacing out a second pregnancy in under 18 months can cause ASD. Doctors have always recommended keeping pregnancies spaced further apart.
This study can be found here. Its interesting reading, but it doesnt give any reasons why this is occurring, its basically statistics.
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Some 5 percent of all babies born in the United States, or 200,000 a year, are exposed to antidepressants in the uterus. While 1 in 150 US children born in 1992 have been diagnosed with autism, 1 in 68 born in 2002 have been.
First Take: The new study is based on records of 145,456 full-term births in Quebec from 1998 to 2009. That puts it on the smaller side . Following the children for an average of six years, researchers led by Anick Bérard of the University of Montreal counted 1,054 with a diagnosis of autism. Among mothers who filled at least one prescription for antidepressants during their second and/or third trimester, the risk of having an autistic child was 1.87-fold higher. Taking SSRIs selective serotonin reuptake inhibitors, such as fluoxetine or paroxetine as opposed to another kind of antidepressant was associated with 2.17 times the risk.
The researchers used standard statistical analyses to separate out factors such as maternal age, poverty, and age at conception, which might make a woman more likely to have a child with autism. Bérard, who has testified for families in lawsuits claiming that antidepressants caused birth defects, called the link to SSRIs biologically plausible. The drugs affect the availability of the neurochemical serotonin, which is involved in numerous steps in brain development.
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Could Taking Certain Medications Increase Your Risk
Researchers have found potential links between the medication a mother takes while pregnant and autism risk. For instance, use of anti-depressants has shown association with autism across multiple studies, says Dr. Fallin, though it remains unclear whether this link is related specifically to the drugs or to the mother’s depression itself. Also, a study in the Journal of the American Medical Association has shown that valproate, a medication used to treat epilepsy and other neurological disorders, can increase the risk for autism. It’s crucial that you work with your doctor to determine whether the benefits of any medications you take outweigh the risks. In many cases, they will: “If a mother has epilepsy, it is very important that it be controlled during pregnancy, even if that requires valproate,” explains Dr. Wang. “If the mother has a seizure while pregnant, that is potentially a much bigger risk to the fetus than the drug that controls her seizures.”
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A Johns Hopkins Study Analyzing Umbilical Cord Blood Samples Found That Newborns With The Highest Exposure To Acetaminophen Were About Three Times More Likely To Be Diagnosed With Adhd Or Autism Spectrum Disorder In Childhood
A new study from researchers at the Johns Hopkins Bloomberg School of Public Health has found that exposure to acetaminophen in the womb may increase a child’s risk for attention deficit hyperactivity disorder or autism spectrum disorder.
The researchers analyzed data from the Boston Birth Cohort, a 20-year study of early life factors influencing pregnancy and child development. They found that children whose cord blood samples contained the highest levels of acetaminophenthe generic name for the drug Tylenolwere roughly three times more likely to be diagnosed with ADHD or autism spectrum disorder later in childhood, compared to children with the lowest levels of acetaminophen in their cord blood.
Their findings were published last week in JAMA Psychiatry.
“People in general believe Tylenol is benign, and it can be used safely for headaches, fever, aches, and pains,” says Xiaobin Wang, a professor in the Bloomberg School’s Department of Population, Family, and Reproductive Health and the study’s corresponding author. “Our study further supports the concerns raised by previous studiesthat there is a link between Tylenol use during pregnancy and increased risk for autism or ADHD.”
Related coverage of what scientists know about autismand what they’re still working to discover
Diseases Of Mother During Pregnancy
The risk of autism in a child of a diabetic mother is twofold than normal one. When the diabetes is not controlled during pregnancy stages, then the child may have oxidative stress, which in turn leads to autism. Nonetheless, the diabetes itself directly doesnt cause autism. Its believed that the thyroid problems in mother may lead to autism, however the hypothesis is yet unproved.
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Obstructive Sleep Apnea In Pregnancy
Sleep apnea can result in intermittent hypoxia and has been increasing in prevalence due in part to the obesity epidemic. The known maternal risk factors for autism diagnosis in her offspring are similar to the risk factors for sleep apnea. For example, advanced maternal age, maternalobesity, maternal type 2 diabetes and maternal hypertension all increase the risk of autism in her offspring. Likewise, these are all known risk factors for sleep apnea.
Infection During Pregnancy Causes Autism A Paper
In a paper recently published in Natures Molecular Psychiatry, M. Hornig et al. examined whether there was a link between maternal exposure to second-trimester fever and autism spectrum disorder risk. What they found was that a pregnant woman who had fevers during her second-trimester was 40% more likely to have a child born with ASD.
Using a prospective cohort study, the researchers followed a group of 95,000 children born in Norway over time, who differ with respect to maternal infections, and attempted to determine if those infections may have caused autism in the children. This study was done in Norway, where medical records are thorough for all citizens of the country, allowing researchers to pinpoint a correlation between a cause and an effect.
The relationship between maternal fevers and ASD seems to increase substantially with three or more maternal fevers, with a 312% increase in the risk of ASD children than mothers without an infection. And fever-reducing medications, such as acetaminophen , seem to reduce the risk for ASD. The researchers arent certain that these medications are a solution, since there other risks to pregnant women when they take them.
There is very strong evidence that a rubella infection during pregnancy leads to a significantly increased risk of autism in her baby. Immunization against rubella before or during may be an effective strategy to reduce the risk of autism in children of those mothers.
The authors concluded that:
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Cannabis Use During Pregnancy Linked To Autism
Researchers from The Ottawa Hospital in Ontario, Canada, have found that children born to mothers who used cannabis while pregnant are more likely to have autism than children born to mothers who did not use the substance while pregnant. Given the legalization of recreational cannabis in many jurisdictions, the study raises concerns over the potential adverse outcomes of prenatal exposure.
For the study, the researchers reviewed medical records of over 500,000 births in Ontario between April 2007 and March 2012. In total, they reported that 0.6% of the mothers studied used cannabis during pregnancy. Meanwhile, 1.4% of children studied were diagnosed with autism. This figure increased to 2.2% if their mother had smoked cannabis during pregnancy.
When controlling for various other factors, the researchers found that 4 in 1000 children born to mothers who used cannabis during pregnancy had autism. In contrast, the same figure was just 2.42 out of 1000 for unexposed children. The researchers also found a link between intellectual disability and learning disorders in children whose mothers used cannabis during pregnancy.
Nevertheless, the findings may be significant enough to encourage pregnant women to exercise caution when using cannabis. This may especially be the case given recent findings showing that women who consume cannabis while pregnant have a higher risk of premature birth, and delivering babies with low birth weight.
Preventing Autism In Pregnancy: Is It Possible
Autism spectrum disorder is a complex condition, affecting 1 in 68 children. But can it be prevented during pregnancy? Experts weigh in on the latest research.
Experts are still trying to piece together what factors contribute to the development of autism. Recent research suggests that changes that occur during conception, pregnancy, and possibly even delivery may increase the risk of autism in children who are genetically predisposed to the disorder.
One study in the New England Journal of Medicinefound differences in the brains of children with autism as early as the second trimester of pregnancy. While researchers havenât been able to pinpoint a definite cause, ASD likely develops from a combination of factors. âSome cases may primarily have a genetic cause, and others may have a primarily environmental cause, but most cases probably result from the interaction of both,â says Paul Wang, M.D., senior vice president of medical research for Autism Speaks.
While you canât do much to change genetics, you can alter your exposure to certain environmental factors that have shown a link to ASD. However, none of these lifestyle changes are absolutesexperts canât tell you that lowering your exposure to one particular factor will lower your childâs risk.
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Which Parent Is Responsible For Autism
In the beginning, experts believed that women were more likely to pass on mutations of genes that induce autism to their children. This is the case due to the fact that girls have a significantly lower prevalence of autism compared to males, and it is considered that females have the same genetically programmed risk factors without the symptoms of autism.
Researchers Determined That Valproic Acid Prevents Nervous System Cells From Properly Developing And Dividing
When used during pregnancy, the drug valproic acid, which is used to treat bipolar disorder, migraines, and epilepsy, can lead to birth defects. Now, research recently published in the journal PLoS Biology by Bill Keyes of the Institute of Genetics and Molecular and Cellular Biology, France, and associates gives one explanation for why: Valproic acid causes certain nervous system development cells to enter a condition known as senescence, which prevents them from properly growing and dividing.
VPA is frequently used to treat a variety of diseases. However, since its first use, there have been many instances of pregnant women using VPA giving birth to kids who had birth abnormalities such as spina bifida, facial changes, and heart malformations. A third of exposed newborns also develop cognitive decline and Autism Spectrum Disorder.
Three mouse embryos, representative of the study that describes how the teratogenic drug Valproic acid can cause neurodevelopmental birth defects in mice, including microcephaly and exencephaly. The embryo on the left is a normal embryo, with no exposure to Valproic acid. The embryo in the middle is smaller and has microcephaly, while the embryo on the right exhibits exencephaly. The middle embryo and the one on the right were both exposed to Valproic acid. Credit: Muriel Rhinn
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Examples Of Developmental Delays
As you continue to monitor your childs development, be mindful of the following five areas where developmental delays are most common:
These are your childs thinking skills. How they think, learn, and learn to solve problems. Every child is different in terms of their level of attention and awareness. However, by a certain age, your child should be capable of understanding their environment and objects in it. Talk to your childs doctor if your child shows signs of a cognitive developmental delay. Some red flags are if your child does not use gestures, does not point to objects or pictures, does not know the function of everyday items, and does not follow instructions when given.
These are skills that your child develops for socialization, getting along with others, and expressing needs. Social or emotional delays are usually apparent before your child reaches school age. Some of the red flags that may indicate a delay include not smiling, not responding with others, lack of facial expressions, lack of interest in games or play, lack of interest in engaging with others and difficulty being comforted.
Trying To Stop Early Labor
In 2011 the United States Food and Drug Department said that injectable terbutaline was not safe for use in pregnant women to stop preterm labor. The drug can cause serious heart problems for the mother, as well as the child. The FDA also said it does not condone the use of the oral tablet for pregnant women either. A study from Duke University found that terbutaline also significantly increased the risk of neurological and cognitive deficiencies in babies whose mother was treated with the drug. The study also showed that the drug predisposed babies to autism. As autism is at an all time high, having risen 172% since 1990, many parents have come to believe this drug is or was the cause of their childâs autism.
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So Pregnancy Complications May Increase The Odds Of Autism: What Does This All Mean
It means science is fascinating and learning more about emerging findings adds stuff to your knowledge bank that you constantly need to deposit new knowledge into to stay up to date.
It does not mean that the pregnancy complications studies have associated with a higher risk of autism are anyones fault, including, of course, the mothers. In short, it doesnt mean you are to blame for your childs autism if you experienced vaginal bleeding or had a preterm labor. It does not mean you could have done anything differently. It doesnt mean that you can simply decide to avoid these pregnancy complications as you try to conceive, like you would avoid alcohol or sushi. Most of the complications that were identified are not ones you can do an awful lot about.
It doesnt mean that pregnancy complications can cause autism on their own. All available evidence indicates that multiple factors have to come together for a person to be autistic.
- Agrawal S, Rao SC, Bulsara MK, et al. Prevalence of Autism Spectrum Disorder in Preterm Infants: A Meta-analysis. Pediatrics. 2018 142 e20180134
Reducing Risk Of Autism During Pregnancy And Birth
Based on the research, there are several steps a birth parent can take to reduce the risk that their child will have autism. They include:
- Having children after the age of 21 and before the age of 35 and choosing a male genetic parent in the same age range
- Working with a doctor to choose safer medications for specific issues, such as epilepsy
- Avoiding activities such as smoking or being around known toxins
- Making regular prenatal visits to the doctor and following up on any potential physical issues, such as emerging gestational diabetes
- Closely following any medical advice regarding bed rest and stress avoidance
According to studies, your baby may also benefit from consistent and appropriate use of specific supplements. Taking supplements such as folate , omega-3s, and vitamin D3, correcting vitamin deficiencies, boosting your immune system, and prolonging breastfeeding are all mentioned in research findings as possible ways to reduce the risk of autism .
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Other Factors Which Can Increase Your Risk Of Autism
The most robust explanation for autism comes from our genetics, Anagnostou said.
But our genes and our environment interact and theres a series of these environmental exposures that have small but consistent effects.
One is infection during pregnancy, and some infections are worse than others.
Thats why we want all moms to be vaccinated. For example, rubella during pregnancy a very high risk of autism.
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Other factors could be maternal diabetes, use of certain medications during pregnancy, an increased paternal age all of these things are robust. We know theyre important to biology, but the actual increase is very small for each one of them so no parent should be feeling guilt because they happen to develop an infection during pregnancy, said Anagnostou.
We have zero evidence that vaccines increase the risk for autism.