Perinatal risk factors associated with autism
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Pregnancy complications identify children who could benefit from early screening and intervention for autism.
A study based on the health records of nearly 600,000 children born in Kaiser Permanente hospitals in Southern California between 1991 and 2009 found strong links between autism and complications before and during birth.This research confirms the findings of earlier studies showing that early-life physical health issues can be used to differentiate babies and toddlers who are at high risk of developing autism.
Children who are exposed to certain perinatal complications, especially birth asphyxia and preeclampsia, are much more likely to be diagnosed with autism. Other perinatal complications that were associated with autism in this latest study included premature separation of the placenta from the uterus, breech/transverse fetal presentation, fetal dystocia/abnormal size or position, and a prolapsed/exposed umbilical cord.
Compared to children not exposed to any perinatal complications, those babies who were exposed to complications only during birth had a 10 percent higher chance of developing autism. That number rose to a 22 percent increased risk of developing autism for children exposed to complications before labour began, and to a staggering 44 percent increased risk for those who were exposed to complications both before AND during birth.
“Early identification of children who may be at risk of developing the disorder is extremely important, as research shows that early intervention treatment services for children with ASD can greatly improve their development.” Dr. Darios Getahun, Kaiser Permanente Southern California Department of Research & Evaluation
Another retrospective birth cohort analysis of nearly 10 million children born in California found that babies who are exposed to meconium-stained amniotic fluid before birth have a significantly increased risk of autism, even after adjusting for factors associated with either premature meconium release or autism such as maternal obesity, preeclampsia, late delivery and prenatal asphyxia. The authors concluded that “resuscitation of neonates with respiratory compromise from in utero meconium exposure may mitigate long-term neurodevelopmental damage” and highlighted the need to elucidate “the molecular mechanisms underlying specific clinical stressors that prompt in utero meconium passage”.
Several recent investigations attempting to illuminate some of the underlying molecular mechanisms behind prenatal autism risk focus on gestational vitamin D deficiency as well as perinatal inflammation and immune activation.
In a recently published study Krakowiak and colleagues looked at over 200 neonatal blood samples of children with a confirmed diagnosis of autism, compared to neonatal blood sample of typical developing children, in order to explore whether immunological signs at birth are predictive of autism. Their study found that specific markers of inflammations are associated with autism later in childhood, and that specific cytokine profiles vary depending on severity of autism.
The increased levels of interleukin IL-1 beta, which plays a central role in the regulation of immune and inflammatory responses to infections, were associated with a threefold increased likelihood of mild to moderate autism, whereas elevated levels of cytokine IL-4 levels, which plays a role in differentiations of immune cells and targeting of immune responses, was associated with a 1.4-fold increase in the likelihood of severe autism.
“In conclusion, our observations collectively suggest that immune factors measured at birth could provide early markers of aberrant neurodevelopmental changes associated with ASD.” (Krakowiak et al. 2017)
Also see: Early childhood health problems point to autism risk (Issue 1)
This article is part of Treating Autism Clinical & Research Newsletter: Issue 2
Getahun D., Fassett M.J., Peltier M.R., et al. (2017) Association of Perinatal Risk Factors with Autism Spectrum Disorder. Am J Perinatol. Feb;34(3):295-304. doi: 10.1055/s-0036-1597624.
Krakowiak P., Goines P.E., Tancredi D.J., et al. (2017) Neonatal Cytokine Profiles Associated With Autism Spectrum Disorder. Biol Psychiatry. Mar 1;81(5):442-451. doi: 10.1016/j.biopsych.2015.08.007.
Miller K.M., Xing G., & Walker C.K. (2017) Meconium exposure and autism risk. J Perinatol. Feb;37(2):203-207. doi: 10.1038/jp.2016.200.
Vinkhuyzen A.A., Eyles D.W., Burne T.H., et al. (2016) Gestational vitamin D deficiency and autism-related traits: the Generation R Study. Mol Psychiatry. Nov 29. doi: 10.1038/mp.2016.213.