1
|
Sim MA, Shen L, Ti LK, Sng BL, Broekman BFP, Daniel LM, Bong CL. Association between maternal labour epidural analgesia and autistic traits in offspring. J Clin Anesth 2023; 89:111162. [PMID: 37352658 DOI: 10.1016/j.jclinane.2023.111162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 04/01/2023] [Accepted: 05/30/2023] [Indexed: 06/25/2023]
Abstract
STUDY OBJECTIVE Studies investigating associations between maternal epidural analgesia (MEA) and autism spectrum disorder (ASD) in the offspring are conflicting and lack prospective neurobehavioral follow-up assessments for autistic traits. We aim to prospectively investigate associations between MEA and autistic traits in the offspring. DESIGN Prospective neurobehavioral observational cohort study. SETTING Singaporean tertiary healthcare institutions. PATIENTS Participants recruited were singleton non-IVF children, >36 weeks gestation, delivered via normal vaginal delivery by mothers >18 years of age, delivered in Singapore from June 2009-September 2010 and followed up over 7 years. INTERVENTIONS Exposure to maternal epidural analgesia during delivery. MEASUREMENTS The primary outcome is an abnormal Social Responsiveness Scale (SRS) T score at 7 years (≥60 points). Secondary outcomes include the diagnosis of ASD and abnormal scores for autistic traits assessed via a neurobehavioral battery comprising: CBCL (child behavioural checklist), Q-CHAT (Quantitative Checklist for Autism in Toddlers), and Bayley-III. Multivariable analyses adjusting for maternal and offspring characteristics were performed. MAIN RESULTS 704 out of 769 mother-child dyads recruited fulfilled the criteria for analysis. 365/704 mothers received MEA. The incidence of an abnormal SRS score at 7 years in offspring exposed to MEA was 19.9%, and 26.1% in non-exposed offspring (p = 0.154). Multivariable analysis did not demonstrate a significant association between MEA and abnormal SRS scores at 7 years (O.R.0.726, 95% C·I. 0.394-1.34, p = 0.305). After adjustment for maternal and fetal demographics, exposure to MEA was not significantly associated with an abnormal screen in all other tests for autistic traits. The clinical incidence of ASD was 1.76% in children without exposure to MEA, and 2.32% in children with MEA exposure (p = 0.506). CONCLUSIONS MEA is not significantly associated with the development of ASD and autistic traits in offspring, assessed over 7 years. Results should be taken into perspective given our wide confidence intervals and small cohort size.
Collapse
Affiliation(s)
- Ming Ann Sim
- National University Hospital, Department of Anesthesia, Singapore.
| | - Liang Shen
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Lian Kah Ti
- National University Hospital, Department of Anesthesia, Singapore; National University of Singapore, Singapore
| | - Ban Leong Sng
- KKH Women and Children's Hospital, Department of Women's Anesthesia, Singapore
| | - Birit F P Broekman
- OLVG and Amsterdam UMC, Department of Psychiatry, Vrije Universiteit, Amsterdam, the Netherlands; Amsterdam Public Health, Mental Health Programme, the Netherlands
| | - Lourdes Mary Daniel
- KKH Women and Children's Hospital, Department of Child Development, Singapore
| | - Choon Looi Bong
- KKH Women and Children's Hospital, Department of Paediatric Anesthesia, Singapore.
| |
Collapse
|
2
|
Sari NP, Jansen PW, Blanken LME, Ruigrok ANV, Prinzie P, Tiemeier H, Baron-Cohen S, van IJzendoorn MH, White T. Maternal age, autistic-like traits and mentalizing as predictors of child autistic-like traits in a population-based cohort. Mol Autism 2022; 13:26. [PMID: 35705965 PMCID: PMC9199218 DOI: 10.1186/s13229-022-00507-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 06/03/2022] [Indexed: 11/10/2022] Open
Abstract
Background Many empirical studies suggest that higher maternal age increases the likelihood of having an autistic child. However, little is known about factors that may explain this relationship or if higher maternal age is related to the number of autistic-like traits in offspring. One possibility is that mothers who have a higher number of autistic-like traits, including greater challenges performing mentalizing skills, are delayed in finding a partner. The goal of our study is to assess the relationship between maternal age, mentalizing skills and autistic-like traits as independent predictors of the number of autistic-like traits in offspring. Methods In a population-based study in the Netherlands, information on maternal age was collected during pre- and perinatal enrolment. Maternal mentalizing skills and autistic-like traits were assessed using the Reading the Mind in the Eyes Test and the Autism Spectrum Quotient, respectively. Autistic-like traits in children were assessed with the Social Responsiveness Scale. A total of 5718 mother/child dyads had complete data (Magechild = 13.5 years; 50.2% girls). Results The relationship between maternal age and autistic-like traits in offspring best fits a U-shaped curve. Furthermore, higher levels of autistic features in mothers are linked to higher levels of autistic-like traits in their children. Lower mentalizing performance in mothers is linked to higher levels of autistic-like traits in their children. Limitations We were able to collect data on both autistic-like traits and the mentalizing skills test in a large population of mothers, but we did not collect these data in a large number of the fathers. Conclusions The relationships between older and younger mothers may have comparable underlying mechanisms, but it is also possible that the tails of the U-shaped curve are influenced by disparate mechanisms. Supplementary Information The online version contains supplementary material available at 10.1186/s13229-022-00507-4.
Collapse
Affiliation(s)
- Novika Purnama Sari
- Department Psychology, Education and Child Studies, Erasmus University Rotterdam, Rotterdam, The Netherlands. .,Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Centre, Rotterdam, The Netherlands. .,Generation R Study Group, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands.
| | - Pauline W Jansen
- Department Psychology, Education and Child Studies, Erasmus University Rotterdam, Rotterdam, The Netherlands.,Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Laura M E Blanken
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Centre, Rotterdam, The Netherlands.,Generation R Study Group, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Psychiatry, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Amber N V Ruigrok
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Peter Prinzie
- Department Psychology, Education and Child Studies, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Henning Tiemeier
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Centre, Rotterdam, The Netherlands.,Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Simon Baron-Cohen
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Marinus H van IJzendoorn
- Department Psychology, Education and Child Studies, Erasmus University Rotterdam, Rotterdam, The Netherlands.,Research Department of Clinical Educational and Health Psychology, UCL, University of London, London, UK
| | - Tonya White
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Centre, Rotterdam, The Netherlands.,Department of Radiology and Nuclear Medicine, Erasmus University Medical Centre, Rotterdam, The Netherlands
| |
Collapse
|
3
|
De Giacomo A, Craig F, Palermo G, Coppola A, Margari M, Campanozzi S, Margari L, Turi M. Differential Diagnosis in Children with Autistic Symptoms and Subthreshold ADOS Total Score: An Observational Study. Neuropsychiatr Dis Treat 2021; 17:2163-2172. [PMID: 34262276 PMCID: PMC8274229 DOI: 10.2147/ndt.s300452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 06/23/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Children with autism spectrum disorder (ASD) share some symptoms with children with other neurodevelopmental disorders (ie, intellectual disability or communication disorders or language disorders). These similarities can make difficult to obtain an accurate diagnosis, which is essential to give targeted treatments to the patients. We aim to verify in our study if children with autistic traits who undergo to Autism Diagnostic Observation Schedule had specific clinical diagnosis. PATIENTS AND METHODS We selected 73 children tested with ADOS-G or ADOS-2, for the presence of autistic symptoms. The whole sample did not reach the cut-off of ADOS and did not receive the ASD diagnosis, according to DSM-5. RESULTS Results of this study showed that in order of frequency and early diagnosis, communication disorders (CD), mild intellectual disability (mID) and the attention deficit hyperactivity disorders (ADHD) represent the most common final clinical diagnosis in children with autistic traits. CONCLUSION Our results showed as the CD was the common diagnosis of these children and that often associated with younger age. Moreover, analyses of ADOS domains and the difference of individual items between groups did not show the capacity to differentiate between different neurodevelopmental disorders in terms of differential diagnosis, and this confirms the need for integrating multiple sources of information during the diagnostic process.
Collapse
Affiliation(s)
- Andrea De Giacomo
- Child Neuropsychiatry Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari "Aldo Moro", Bari, Italy
| | - Francesco Craig
- Department of Cultures, Education and Society, University of Calabria, Rende, Italy
| | | | - Annamaria Coppola
- Child Neuropsychiatry Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari "Aldo Moro", Bari, Italy
| | - Mariella Margari
- Child Neuropsychiatry Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari "Aldo Moro", Bari, Italy
| | - Stella Campanozzi
- Child Neuropsychiatry Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari "Aldo Moro", Bari, Italy
| | - Lucia Margari
- Child Neuropsychiatry Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari "Aldo Moro", Bari, Italy
| | - Marco Turi
- Fondazione Stella Maris Mediterraneo, Potenza, Italy
| |
Collapse
|
4
|
Trzmiel T, Purandare B, Michalak M, Zasadzka E, Pawlaczyk M. Equine assisted activities and therapies in children with autism spectrum disorder: A systematic review and a meta-analysis. Complement Ther Med 2018; 42:104-113. [PMID: 30670226 DOI: 10.1016/j.ctim.2018.11.004] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 11/01/2018] [Accepted: 11/02/2018] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION The multifactorial nature of Autism Spectrum Disorder (ASD) is the reason why complementary and alternative methods of treatment are sought in order to support the classic approach. OBJECTIVES The aim of the study was to assess the effectiveness of Equine-Assisted Activities and Therapies (EAAT) in ASD patients based on a review of the literature. METHODS A review of the literature and a meta-analysis were conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PUBMED, Cochrane Library, Web of Science, ClinicalTrials.gov and PEDro databases were searched until July 20, 2017. Only articles published in English, in a journal with a review process, after 1999, with a control group or presentation of comparative pre-/post-therapy results in ASD patients, and clear inclusion/exclusion criteria were considered. The methodological quality of the included studies was assessed using the Quality Assessment Tool for Quantitative Studies (QATQS).The meta-analysis of three studies was conducted. RESULTS A total of 15 studies with 390 participants (aged: 3-16 years) were included. The interaction between psychosocial functioning and EAAT was investigated in most studies. Improvement was reported in the following domains: socialization, engagement, maladaptive behaviors, and shorter reaction time in problem-solving situations after EAAT. The meta-analysis revealed no statistically significant differences for the investigated effects. CONCLUSIONS Despite the need for further, more standardized research, the results of the studies included in this review allow us to conclude that EAAT may be a useful form of therapy in children with ASD.
Collapse
Affiliation(s)
- Tomasz Trzmiel
- Department of Geriatric Medicine and Gerontology, Poznan University of Medical Sciences, Poland.
| | - Barbara Purandare
- Department of Geriatric Medicine and Gerontology, Poznan University of Medical Sciences, Poland
| | - Michał Michalak
- Department of Computer Science and Statistics, Poznan University of Medical Sciences, Poland
| | - Ewa Zasadzka
- Department of Geriatric Medicine and Gerontology, Poznan University of Medical Sciences, Poland
| | - Mariola Pawlaczyk
- Department of Geriatric Medicine and Gerontology, Poznan University of Medical Sciences, Poland
| |
Collapse
|