Warning signs: Data indicates that autistic mothers are at higher risk for postpartum anxiety and depression.

New guidelines for pregnancy in multiple sclerosis
New research from the Policy and Analytics Center at Drexel University’s A.J. Drexel Autism Institute looked into perinatal and postpartum outcomes among individuals with intellectual and developmental disabilities.

American women have the highest rate of maternal deaths among high-income countries, with outcomes worse for minoritized groups. In a recent study published in JAMA Network Open, researchers from Drexel University’s Policy and Analytics Center in the A.J. Drexel Autism Institute examined Medicaid data to better understand and identify perinatal and postpartum outcomes among people with intellectual and developmental disabilities, including autism and intellectual disability. 

Lindsay Shea, DrPH, director of the Policy and Analytics Center in the A.J. Drexel Autism Institute and lead author of the study, highlighted that while previous studies have reported an increased risk for challenges related to pregnancy and birth among people with intellectual and developmental disabilities, little research has been done using United States-based population-level data. Medicaid, as it covers almost half of births in the U.S. and a disproportionate share of people with intellectual and developmental disabilities, is a key system to study these risks and opportunities for policy and program improvements. The study revealed that people with intellectual and developmental disabilities were younger at the time of their first delivery and had higher risks for multiple medical and mental health conditions, such as gestational diabetes, gestational hypertension, and preeclampsia. Autistic pregnant individuals had a significantly higher probability of experiencing postpartum anxiety and postpartum depression compared to people with intellectual disabilities only and those without intellectual and developmental disabilities.

Researchers examined national Medicaid claims to compare perinatal and postpartum outcomes across groups of birthing people with intellectual and developmental disabilities (including intellectual disability and autism) and a random sample of birthing people without intellectual and developmental disabilities. The data included Medicaid claims from 2008-2019 for 55,440 birthing people with intellectual and developmental disabilities and a random sample of 438,557 birthing people without intellectual and developmental disabilities.

The study compared perinatal outcomes, including medical conditions like gestational diabetes, gestational hypertension, and preeclampsia, as well as mental health conditions such as anxiety disorders and depressive disorders, across different groups. Researchers used Kaplan-Meier and Cox proportional hazard regressions to estimate the likelihood of postpartum anxiety and postpartum depression.Co-author Molly Sadowsky, project director at the Policy and Analytics Center in the Autism Institute, explained that the findings suggest several opportunities for policymakers, providers, and researchers. It is important to tailor reproductive health education, perinatal care, and delivery services to provide comprehensive and targeted support for birthing individuals with intellectual and developmental disabilities. Policies should be designed and implemented to meet the needs of people with intellectual and developmental disabilities, with the goal of reducing maternal health disparities. Clinical guidelines and procedures should be adjusted to accommodate the specific needs and experiences of people with intellectual and developmental disabilities. Additionally, new Medicaid policies, such as the postpartum coverage extension and doula service reimbursement, should be evaluated for their impact on the health outcomes of people with intellectual and developmental disabilities.

“The findings of this study emphasize the urgent need for Medicaid to support birthing individuals with intellectual and developmental disabilities during the perinatal period,” said Sadowsky. “It’s crucial to address differences in access to postpartum care and coordination, as well as the related disparities in the risk of postpartum depression and anxiety.”Shea and Sadowsky also explained their plans for future work, stating, “In our next project, we will further this research by examining the impact of attitudinal and structural ableism on perinatal health and mental health outcomes, as well as on neonatal and postnatal outcomes, morbidity, and mortality among children of women with and without intellectual and developmental disabilities,” said Shea.

Shea and her research team have been granted a five-year, $3 million National Institutes of Health Research Project Grant (R01) to further investigate the impact of ableism on women with intellectual and developmental disabilities during pregnancy and the postpartum period. The upcoming study will involve a detailed examination and comparison of outcomes experienced by this group and their infants to those of peers without intellectual and developmental disabilities. Shea expressed her enthusiasm about the future of their work in this area, emphasizing the importance of supporting individuals and celebrating their birthing experiences and roles during these significant times in life.

New knowledge about the link between infection during pregnancy and autism

New knowledge about the link between infection during pregnancy and autism
New knowledge about the link between infection during pregnancy and autism

Infections in pregnant women have been linked to an increased risk of neurodevelopmental conditions, such as autism, in the child later in life. But it does not seem to be the infections themselves that cause autism, researchers from Karolinska Institutet in Sweden show in a study published in The Lancet Psychiatry.

“Our results can reassure expectant parents by indicating that infections during pregnancy may not pose as great a risk to the baby’s brain as previously thought,” says Håkan Karlsson, researcher at the Department of Neuroscience at Karolinska Institutet and the study’s senior author.

Previous studies have shown a link between infections in the expectant mother during pregnancy and an increased risk of neurodevelopmental conditions, such as autism or intellectual disability, in the child later in life.

But they have not been able to say whether the mother’s exposure to infection is truly the cause or whether other factors are behind this link. Researchers from Karolinska Institutet have now studied this in more detail.

The current study is based on data on more than 500,000 children born between 1987 and 2010. The aim was to investigate whether there is a causal relationship between infections in the woman during pregnancy and autism or intellectual disability in the child. Infections were included if they were severe enough to requirespecialist care and they were identified using diagnostic codes from patient and birth records.

Similar to previous studies, the researchers could see that infections that required specialist care during pregnancy were linked to an increased risk of autism and intellectual disability in children.

But when the researchers studied siblings, the result was different. In comparisons between sibling pairs where the mother had had an infection during one pregnancy but not the other, they could not find any link between infection and the children’s risk of autism. For intellectual disability, the link was weaker when the researchers compared sibling pairs than when they compared children who are not related.

The researchers also examined the risk of autism and intellectual disability in children if their mother had been diagnosed with an infection during the year before her pregnancy. The idea was that infection before pregnancy would not be linked to an increased risk of autism and intellectual disability if it really was the infection during pregnancy causing the neuropsychiatric conditions.

Here, the researchers could see that infections during the year before pregnancy were linked to the risk of autism to the same degree as infections during pregnancy, but not linked to the risk of intellectual disability.

“The link between infections in pregnant women and the increased risk of autism in their children does not appear to be causal. Our results suggest that the increase in risk is more likely to be explained by factors common between family members, such as genetic variation or certain aspects of the shared environment,” says Martin Brynge, PhD student at the Department of Global Public Health, Karolinska Institutet, and one of the study’s two first authors.

Since the results were less clear for intellectual disability, it cannot be ruled out that infections during pregnancy may affect children’s risk for this condition. In any case, infections during pregnancy may not influence the risk of intellectual disability to the same extent as previously thought, according to the researchers.

The researchers emphasise that they have only looked at diagnosis of infections in general. The study does not contradict the significance of the well-established links between some specific viral infections during pregnancy, such as cytomegalovirus infection and rubella, and the risk of serious developmental conditions in the child. The researchers also point out that infections by the agent causing COVID-19 were not included in their study. It is still critical for pregnant women to follow their midwife’s advice regarding infection control.

New guidelines for pregnancy in multiple sclerosis




New guidelines for pregnancy in multiple sclerosis

New guidelines for pregnancy in multiple sclerosis




 

New guidelines for pregnancy care in multiple sclerosis, drawn up by a panel of UK experts, have been published this week.

They aim to reduce uncertainty about treatments that are safe and appropriate for pregnant and breastfeeding women with MS, and for couples affected by MS who are planning a pregnancy.

MS is usually diagnosed among 20-40 year olds, two thirds of whom are women. Around this age, both men and women might be planning to have children. At the same time, it is becoming increasingly clear that disease modifying drugs (DMDs) should be started as early as possible. Delaying DMD treatment until after having a family can lead to irreversible disability in the long term. For this reason, it makes sense to start discussing family planning and pregnancy early after diagnosis, alongside discussions about DMDs, if appropriate.




However, there is limited evidence available to guide these discussions, and so the MS Trust and a group of very experienced health professionals set out to develop a set of consensus guidelines to bring clarity to this area. The guidelines have been endorsed by the Association of British Neurologists, and have been reviewed by a panel of MS specialist nurses, neurologists, obstetricians, midwives and people with MS as part of the development process.

Read more here