Early Prenatal Anemia May Increase Risk of Autism, ADHD

A new Swedish study suggests anemia early in pregnancy may increase the risk of autism, ADHD and intellectual disability in children. Anemia is a common condition in late pregnancy and researchers discovered anemia toward the end of pregnancy did not have the same correlation.

The findings, published in JAMA Psychiatry, underscore the importance of early screening for iron status and nutrition counseling.

An estimated 15-20% of pregnant women worldwide suffer from iron deficiency anemia — lower blood oxygen levels due to a lack of iron. By the third trimester, pregnant women have nearly 50% more blood than they did pre-pregnancy in order to provide enough oxygen for both the woman and the fetus, and their iron requirements are nearly double that of nonpregnant women. Thus, the vast majority of anemia diagnoses are made toward the end of pregnancy, when blood levels are at their highest.

In the current study, the researchers examined what impact the timing of an anemia diagnosis had on the fetus’ neurodevelopment. Investigators specifically assessed if there was an association between an earlier diagnosis in the mother and the risk of intellectual disability (ID), autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) in the child.

Overall, very few women are diagnosed with anemia early in pregnancy. In this study of nearly 300,000 mothers and more than half a million children born in Sweden between 1987-2010, less than 1% of all mothers were diagnosed with anemia before the 31st week of pregnancy. Among the 5.8% of mothers who were diagnosed with anemia, only 5% received their diagnosis early on.

The researchers found that children born to mothers with anemia diagnosed before the 31st week of pregnancy had a somewhat higher risk of developing autism and ADHD and a significantly higher risk of intellectual disability compared to healthy mothers and mothers diagnosed with anemia later in pregnancy.

Among the early anemic mothers, 4.9% of the children were diagnosed with autism compared to 3.5% of children born to non-anemic mothers, 9.3% were diagnosed with ADHD compared to 7.1%, and 3.1% were diagnosed with intellectual disability compared to 1.3%.

After considering other factors such as income level and maternal age, the researchers concluded that the risk of autism in children born to mothers with early anemia was 44% higher compared to children with non-anemic mothers. The risk of ADHD was 37% higher and the risk of intellectual disability was 120% higher.

Even when compared to their siblings, children exposed to early maternal anemia were at higher risk of autism and intellectual disability. Importantly, anemia diagnosed after the 30th week of pregnancy was not associated with a higher risk for any of these conditions.

“A diagnosis of anemia earlier in pregnancy might represent a more severe and long-lasting nutrition deficiency for the fetus,” says Renee Gardner, project coordinator at the Department of Public Health Sciences at Karolinska Institutet and the study’s lead researcher.

“Different parts of the brain and nervous system develop at different times during pregnancy, so an earlier exposure to anemia might affect the brain differently compared to a later exposure.”

The researchers also noted that early anemia diagnoses were associated with infants being born small for gestational age while later anemia diagnoses were associated with infants being born large for gestational age.

Babies born to mothers with late-stage anemia are typically born with a good iron supply, unlike babies born to mothers with early anemia.

Although researchers could not specify whether iron deficiency anemia is more detrimental than anemia caused by other factors, iron deficiency is by far the most common cause of anemia. Investigators say the findings may thus support regular iron supplementation in maternity care.

Scientists emphasize the importance of early screening for iron status and nutrition counseling but note that more research is needed to find out if early maternal iron supplementation could help reduce the risk of neurodevelopmental disorders in children.

Adult women 19 to 50 years old typically need 18 mg of iron per day, though needs increase during pregnancy. Since excessive iron intake can be toxic, pregnant women should discuss their iron intake with their midwife or doctor.

Source: JAMA

Depression is the Strongest Predictor of Substance Use in Pregnancy

A new Canadian study finds that depression is the single largest driver of substance use during pregnancy, highlighting the need for greater support for the mental health of pregnant women.

According to the Centers for Disease Control and Prevention (CDC), the rate of pregnant women with a depression diagnosis at delivery increased by seven times from 2000 to 2015. And it is well known that drug and alcohol use during pregnancy is linked to poor birth outcomes, but some women continue to use these substances while pregnant.

For the study, a research team from Western University in Ontario and its affiliate, Brescia University College, investigated the potential predictors of cannabis, tobacco and alcohol use among pregnant women. They analyzed the health and geographical data of more than 25,000 pregnant women in Southwestern Ontario.

The research, published in the Journal of Neonatal-Perinatal Medicine, is the first Canadian study with a sample size this large to show that depression during pregnancy is the primary risk factor for cannabis, tobacco and alcohol use. In fact, depression was found to be a stronger predictor than education, income or age.

“Pregnant women who were depressed were 2.6 times more likely to use cannabis and twice as likely to smoke cigarettes and use alcohol while pregnant,” said Jamie Seabrook, PhD, an associate professor at Brescia and Western’s Schulich School of Medicine & Dentistry, and scientist at Children’s Health Research Institute, a Lawson program.

“We don’t know when the substance use first began, but we do know that it was continuing during pregnancy and that is a big risk factor for poor maternal and infant health outcomes.”

First author Rachel Brown says that the study really emphasizes the importance of focusing on pregnant women’s mental health. This might include better promotion of mental health strategies, psychotherapy and/or safe and proper mental health medication during pregnancy.

“The research shows that there is an effect later on in life as well with infants who are born preterm or low birth weight. To intervene or advocate for mental health programs for the mom, the idea is that it sets up the health of the infants later on in life,” said Brown, an MSc candidate.

The research team points out that this research is especially important in Canada with the recent legalization of recreational cannabis.

“Let’s help women with their mental health to improve their overall health and in doing so, improve the health of their baby,” said Seabrook.

Source: University of Western Ontario

Many Expectant Moms Feel Pushed Out of Their Jobs

Many pregnant women feel like they are pushed out of their jobs, while new fathers tend to get a career boost, according to a new study published in the Journal of Applied Psychology.

Researchers from Florida State University (FSU) investigated two long-standing theories on why new mothers are more likely to leave the workforce than new fathers: The first theory suggests that pregnant women decide for themselves to “opt out” of work due to changing personal and career values. The second indicates that pregnant women often feel “pushed out” of the workplace.

The new findings suggest that the first notion is often driven by the second. In other words, the researchers found that inherent biases do exist against expectant mothers, which in turn makes them feel unwelcome in the workplace, often leading to them to opt out.

“We found that pregnant women experienced decreased career encouragement in the workplace only after they disclosed they were pregnant,” said Samantha Paustian-Underdahl, assistant professor of management at FSU’s College of Business, who has been studying the issue of expectant mothers in the workplace for six years.

“Once they told managers and co-workers, we saw a decline in career encouragement for women but an increase in career encouragement for men.”

That kind of contrasting treatment between men and women in the workplace has been documented in previous work. Known as the “motherhood penalty” and “fatherhood premium,” researchers have attributed both to old cultural stereotypes that favor fathers as breadwinners and women as caregivers.

Labor statistics back up that financial contrast: When couples have children, women’s salaries tend to go down while men’s go up, yet few studies have been able to pinpoint the causes of those wage differences.

“This is one of the first studies to look at the workplace experiences of both men and women, and it shows men get benefits from parenthood that women don’t,” Paustian-Underdahl said.

The findings did not find examples of pregnant women becoming less enthusiastic about working, however.

“Contrary to expectations, career motivation increased for both men and women over the pregnancy,” Paustian-Underdahl said. “We expected career motivation to decrease for mothers throughout pregnancy, but we found the opposite to be true.”

But if expectant moms felt pushed out by an organization, then their career motivation dropped and they chose to leave their jobs. “This is the first study to show that being pushed out can actually drive women to adopt an opting-out attitude,” she said.

The research offers new ideas on how to treat expectant women. Primarily, workplaces should not reduce their career-related encouragement toward pregnant employees. Furthermore, managers should provide both fathers and mothers with social and career support to help them attain their work and family goals.

Paustian-Underdahl hopes her findings prompt all workers to stop making assumptions about men and women with children.

“If employers want to retain top talent, they should have honest conversations with employees about their career goals and plans, and then managers need to provide support to help employees achieve those goals,” she said. “Organizations need to give their workers the encouragement they’re looking for because, in this study, pregnant women really wanted career support, and they did not get it.”

Source: Florida State University