Pregnancy is the most delicate stage, and it’s where a lot of care and concern is required. Pregnant women go through a lot of hormonal changes as a result of which the child in the mother’s womb is exposed to these changes. Baby’s earliest environment is critical; scientists have found out that autism develops during pregnancy.  High blood pressure or abnormal bleeding during pregnancy, as well as complications such as caesarean delivery or extremely preterm birth (<26 weeks), may all increase the risk of autism.

Autism is part of larger group of related conditions called autism spectrum disorder. Exact causes of autism are still unclear. Autism is primarily genetic in origin, but a growing list of preterm exposures for mother and baby may sway the odds. The baby’s earliest environment, the womb, is critical because the foetal brain produces about 250,000 neurons every minute during pregnancy and experiences that interfere with that process can affect the developing brain in lasting ways.

Studies have linked autism to a number of factors in pregnancy, which includes the mother’s diet, the medicines she takes and her mental, immune and metabolic conditions, including preeclampsia (a form of high blood pressure) and gestational diabetes. Use of psychiatric drug during pregnancy in women with Gestational Diabetes Mellitus increases the risk two-fold. Coagulation disorder, intra uterine growth retardation, auto immune diseases, maternal obesity malignancy and prenatal viral infection are some of the other risk factors.

Other preliminary work has implicated the quality of the air she breathes and the pesticides she is exposed to. And some research suggests that birth complications and birth timing may also play a role. Autism has been tied to events throughout pregnancy, including the first few days after conception.

The last trimester is a time of significant growth in a baby's size and weight. However, most crucial brain development occurs in the first and second trimesters. During this early pregnancy period, important brainstem mechanisms form the foundation for subsequent brain development. So far, research indicates that increased risk for autism traces most strongly to what happens during the first and second trimesters.

Any delays in speech, language or motor development require prompt assessment and referral to an appropriate therapist (speech, occupational, physical, etc.) It’s equally important to monitor for any hearing loss, as this will predispose to language delays.

A 2014 study in the American Journal of Epidemiology found that children born to iron-deficient mothers are five times more likely to develop autism. The risk increases when the mother is 35 or older or has a metabolic condition such as obesity, high blood pressure or diabetes. Boy babies are four times more likely to develop autism. Family history – families who have one child with ASD have high risk of having another child with the disorder. Recent controversy arose regarding the association between vaccination and autism. However, evidence has disproved this postulate, provided care is exercised about the date of expiry of the vaccine.

A woman’s health is essential to the good health of her baby. Women who eat well and exercise regularly along with regular prenatal care are less likely to have complications during pregnancy. They’re also more likely to successfully give birth to a healthy baby. Eating a nutritious diet during pregnancy is linked to good foetal brain development, a healthy birth weight, and it reduces the risk of many birth defects. Good nutrition is thought to help balance mood swings and it may improve labour and delivery as well. A balanced diet will also reduce the risks of anaemia, as well as other unpleasant pregnancy symptoms such as fatigue and morning sickness.

Dr Nithya Ramamurthy, MBBS, DGO is an Obstetrician and Gynaecologist, Fortis Malar Hospital, Chennai

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