Autism Spectrum Disorder and Pre Gestational Diabetes – a link?
12 July 2019
Prenatal exposure to metabolic disturbances is associated with neurodevelopmental impairment and autism spectrum disorder (ASD) in children. That has been known for quite some time.
What has been less clear is whether similar factors are linked to other mild neurodevelopmental disorders.
Recent studies back in late 2018 have suggested that the long suspected link between Attention Deficit Hyperactivity Disorder (ADHD) and Obesity in pregnancy is probably made out.
Frequently we are faced with clients who advise that their weight or diabetes was not properly managed or they were not properly advised about the risks. A parent will often say they were not advised to lose weight. A large cohort study in the USA published in September 2018 confirmed the indication that severely obese mothers had a 67% to 88% increased risk of having a child with mild neurodevelopmental disorders, ADHD or conduct disorder and/or psychotic, mood and stress related disorders.
Pre gestational diabetes mellitus (existent diabetes before pregnancy) has long been known to be an increased risk factor, presenting with significant challenging medical complications of pregnancy due to the need for frequent monitoring and medication adjustments and the risk of fetal complications. It is perhaps interesting that the most recent study could not categorically show that gestational diabetes increased the risk of these conditions occurring.
Obesity in pregnancy does also increase the risk of:
- Pregnancy loss – Obese women have an increased risk of pregnancy loss (miscarriage) compared with women of normal weight.
- Birth defects – Babies born to obese women have an increased risk of having birth defects, such as heart defects and neural tube defects.
- Problems with diagnostic tests – obesity can make it difficult to see certain problems with the baby’s anatomy on an ultrasound exam. Checking the baby’s heart rate during labour also may be more difficult if you are obese.
- Macrosomia – where baby is larger than normal. This can increase the risk of the baby being injured during birth, for example, shoulder dystocia. Macrosomia also increases the likelihood of needing a caesarean delivery. Infants born with too much body fat also have a greater chance of being obese later in life.
- Preterm birth - obesity can also increase the likelihood of preterm birth. This means that there is a risk of babies not being as fully developed as babies who are born after 39 weeks of pregnancy. As a result, they have an increased risk of short-term and long-term health problems.
- Stillbirth - The higher the woman’s BMI, the greater the risk of stillbirth.
The impact however cannot be understated as for many of these children one of the long term effects is that the medication used to treat these conditions does also lead to weight gain (due to increased appetite) and thereafter further psychological impact.
The associated factors of obesity cannot be understated in pregnancy and they must be reflected appropriately in a birth plan and properly reviewed throughout. If as a mother you are overweight, or have diabetes in the pregnancy despite what any midwife may tell you, a standalone birthing centre for instance is not going to be a safe choice for your birth.
If you believe that a caesarean section is the right choice for your delivery you have a right to exercise this choice.
Appropriate management can save a pregnant mother a lot of stress during pregnancy, and unjustified guilt and worry in the future.
Head of Clinical Negligence and Catastrophic Injury
The Clinical Negligence and Catastrophic Injury Team at Curtis Law is led by Jerard Knott, Senior Associate Solicitor, an APIL Accredited Senior Litigator and Clinical Negligence Specialist. It also includes Lynne Ainsworth, a Law Society Accredited Clinical Negligence Panel Member. We are committed to promoting Patient Safety. The team only acts for Claimants and is dedicated to providing a client care centered high level of service, providing the best possible advice and maximising damages. The department acts on a large number of fatal (including representation at Inquests) and high value cases. The department regularly advises on cases with valuation exceeding £1,000,000. We can be contacted on 01254 297130 or MedNeg@curtislaw.co.uk. Follow us at @curtislaw for up to date commentary and sector advice.