Obstetrical and delivery-related conditions have gained much interest, so the use of synthetic oxytocin (OT) to induce and/or augment labor underwent a study by (Weisman O et al, 2015), they found that maternal exposure to OT during birth may have adverse effects on the infant’s development, including increased risk for autism. This findings suggest an association between OT-augmented labor and risk for autism in males. However, Future studies should also investigate dose dependent effect of OT on infant’s development.
Oxytocin (OT) secreted into the blood from the the posterior pituitary in a pulsatile manner, stressful conditions such as heavy blood loss, prolonged labour, or Caesarean section, instead of the pulsatile release there is a steady secretion (Olza Fernández I et al, 2011). The physiological, peak post-partum increase of OT in the maternal brain produces a feeling of euphoria, lighter sleep, and an increased pain threshold in the mother and reduces feelings of stress via a reduction in cortisol levels, species (Matthiesen AS et al, 2001). In elective, Caesarean births where no labour is involved, this endogenous OT peak does not occur, exogenous OT can impair the initiation of lactation by altering the pulsatile release of OT and the fluctuations in OT concentration; by desensitising the receptors; and, more and by altering infant or maternal behaviour (Jonas K et al, 2009). In Levels of this hormone are increased more in women who maintain skin-to-skin contact with their infants, and they also have further elevations of OT levels in connection with periods of breastfeeding (Matthiesen AS et al, 2001).10
Asystematic review and meta-analysis on mode of delivery and ASD reported a 23% increased risk of ASD in relation to CS, but clearly understanding the interrelationship between environmental factors such as mode of delivery and genetic susceptibility requires further attention (Curran E et al, 2015) Neonates delivered by C-section with general anesthesia were associated with a higher incidence of autism than neonates delivered vaginally or those delivered by C-section with regional anesthesia. The suggested explanation was that neurotoxicity resulting from neonatal exposure to anesthesia might affect later neurodevelopment in children. (Chien LN et al, 2015)
Till now the available data do not enable us to be sure of the true effect of cesarean section from the underlying indications to this operative procedure (such as failure to progress in labor, fetal distress, multiple pregnancies, breech presentation). It looks that mechanical interventions in delivery play as environmental factors, also, the progress occurred in the last decades in neonatal management has led to increased survival of preterm infants, but as a consequence of this a growing number of severe disabilities may be anticipated during childhood (Guinchat V et al, 2012).
Study of (Larsson HJ et al, 2005) maternal education, risk factors: breech presentation, low Apgar score, and gestational age at birth of less than 35 weeks were examined as risk factors, the results showed that no statistically significant association was found between autism and maternal education while In the unadjusted analyses, breech presentation, lowApgar score less than 7 at 5 minutes, low birth weight less than 2,500 gram, gestational age at birth of less than 35 weeks, and being small for gestational age were associated with a statistically significantly increased risk of autism
Neonatal hypoglycemia and neonatal jaundice were associated with increased risk of autistic disorders for term but not preterm infants, also being born small for gestational age with neonatal hypoglycemia doubled the risk of autistic disorders (Buchmayer S et al, 2009) Newborn with Very low birth weight (less than1500 g) and low birth weight less than 2500 g), gestational age less than 32 weeks), and SGA increased risk of childhood autism. Very low and moderately low birth weight, very low gestational age, and SGA were also associated with increase in PDD risk (Lampi KM et al, 2012)
Preterm baby with VLBW often in need to long hospitalizations in the neonatal intensive care unit (NICU). The infants in the NICU are treated with highly advanced medical technology and the number of survivors increased, but neurodevelopmental consequences still exist (Vandenberg KA, 2007).28 The NICU infants may experience postnatal complications such as intraventricular hemorrhages, which may mediate the effects of intrauterine growth restriction and prematurity on the risks of autism and PDD. It was suggested that the proportion of NICU infants that are later classified with ASD has increased (Karmel BZ et al, 2010).29 It is also possible that the environment of the NICU adversely affecting physiological, emotional, and social maturation may result in negative effects on child neurodevelopment (Gooding JS et al, 2011).28,31
Severe inflammatory pain in neonates and persistent inflammatory reactions may predispose premature infants to development delays and psychiatric disorders including ASD (Lee JH et al, 2016). In clinical practices, premature infants in the neonatal intensive care unit (NICU) are routinely exposed to an average of ten therapies or procedures per day without analgesics (Carbajal R et al, 2008). Many of the procedures are painful and may cause inflammatory responses and local tissue edema/damage. It is now believed that infants are more sensitive to pain due to the incomplete development of the brain and the descending inhibitory tracts in their spinal cord (Page GG 2004). Studies of (Anand KJ 2000) and (Anand KJ and Scalzo FM, 2000) were supporting to the previous idea and showed that inflammatory pain experienced during the postnatal period may cause abnormal adult behaviors such as increased anxiety, altered pain sensitivity, hyperactivity, self-destructive behavior, or reduced social behaviors. A study applied on 1.2 million pregnancies showed that the risk of autism in the children of women with the highest levels of C-reactive protein, a well known marker of inflammation, was 43 % higher than women with the lowest levels (Brown AS et al, 2014)
Unconjugated hyperbilirubinemia may be linked to ASD and may have affected the prevalence of ASD globally. The severity of unconjugated hyperbilirubinemia based on unbound unconjugated bilirubin this result explained by the theory of the pathogenesis of bilirubin-induced neurotoxicity, free unconjugated bilirubin crosses intact blood brain barrier and causes neurotoxicity. (Amin SB et al, 2011). Also( Maimburg RD et al 2008) found fourfold risk for infantile autism in infants who had hyperbilirubinaemia after birth. but the association appeared limited to term infants (37 or more weeks gestation).
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