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What If Autism Risk Could be Diagnosed At Birth?

(Illustration: Patrick Lynch, Yale University)

(Illustration: Patrick Lynch, Yale University)

By Karen Weintraub
Guest Contributor

In what might ultimately be a game-changer for managing and treating autism, Yale researchers report that they can now identify kids at risk for autism right after birth — instead of waiting until they’re diagnosed at age 3 or 4 — by examining their mother’s placenta.

Harvey Kliman, M.D., a research scientist in the Department of Obstetrics, Gynecology & Reproductive Sciences at the Yale School of Medicine, says he is able to make such a determination by looking for abnormal folding in the newborn’s placenta – the organ that feeds the baby during pregnancy. Kliman’s study, based on examining 217 placenta samples, is out today in the journal Biological Psychiatry.

By finding these children early, the hope is that they can begin aggressive therapy that will compensate for any behavioral, social or communications difficulties they would otherwise have had.

“Now we have something that can flag children at birth,” says Kliman, a placenta expert and lead author of the study.

A Child With Faulty Folding

Chris Mann Sullivan is a believer.

Sullivan, a longtime autism behavioral therapist, sent her newborn daughter Dania’s placenta to Kliman three years ago because she thought she might recommend the analysis to her clients and wanted to try it herself.

Kayla and Dania Sullivan (Photo: Chris Mann Sullivan)

Dania Sullivan, at right, was flagged at birth for being at risk for autism. Her older sister Kayla does not have the condition. (Photo: Chris Mann Sullivan)

To her shock and horror, Kliman saw evidence of this faulty folding in Dania’s placenta.

Once she recovered from her surprise, Sullivan began to try the therapies she knew so well on her own child, adapting them for Dania’s young age. Sullivan, of Norman, NC, describes her approach as intensive, “really, really good parenting.” Instead of letting tiny problems resolve themselves, she addressed them aggressively.

As a baby, when Dania, would only look and roll in one direction, Sullivan started encouraging her to use the other arm.
When the child didn’t intuitively understand facial expressions, Sullivan spent hours showing her pictures of familiar people smiling. And when Dania, who had asthma, began getting sick a lot and couldn’t seem to bounce back, Sullivan started giving her preventive nebulizer treatments every time she came in from playing outside.

Last summer, when Dania, now 3, didn’t want to stay in a wet bathing suit, her mother quickly changed it – and then regretted it when Dania’s reaction escalated into a fear of anything wet.

“You would have thought the world would have ended the first time we did not put on a dry bathing suit,” said Sullivan. But now Dania is over her aversion. “We pushed through it. Pushing through it with little kids is a lot different than pushing through with an older child.”

And that’s why it’s so important for parents to know that their child may need extra help at the very beginning of life, rather than waiting for counterproductive patterns to get established, Continue reading

Mass. Teen Birth Rate Hits Record Low; Black Infant Mortality Tops Whites

WBUR’s Martha Bebinger reports on new data released by the state Department of Public Health:

Seventeen out of 1000 teenagers in Massachusetts had a baby in 2010. That’s half the national average. Patricia Quinn, director of the Massachusetts Alliance on Teen Pregnancy, says teenagers today do a better job with contraception than did their parents.

 (kristaguenin/flickr)

(kristaguenin/flickr)

“That’s not a message that adults wrap their heads around on a regular basis that young people could be doing more right than we did when we were teens and that is definitely the case when it comes to teen pregnancy and sexual behavior,” Quinn said.

Quinn says state figures out today also shows that teen abortion rates have declined 68% since a peak in 1989. And teen births rates are at a record low.

Black babies continue to a have much greater chance of dying before their first birthday in Massachusetts as compared to white infants….

The Public Health report says the black infant mortality rate is almost two and half times that of white infants. The gap has been higher, but health leaders say the numbers are still unacceptable. Department of Public Health interim commissioner Lauren Smith.

“This just remains a call to us to focus even more intensely on the health of women of childbearing age before they even become pregnant,” Smith said.

Pregnancy Dilemma: Premature Delivery Or Risk Of Stillbirth?

This is like a card game with the highest stakes in the world, I thought as I read Boston-based science writer Eugenie Reich’s harrowing story of the choice she faced when she was carrying a fetus whose growth was badly lagging. It’s on Slate: “When is it right to let your unborn baby die?”

Pregnancy can be full of dilemmas that require you to weigh the odds. Do you have an invasive genetic test even if there’s a small chance it will cause a miscarriage? If labor is progressing poorly, do you have a Cesarean section?

But I had never before heard of the either-or that confronted Eugenie: She could choose to deliver early, very early, and her child would face all the likely complications and disabilities of extreme prematurity. Or she could continue to carry the fetus, thus risking a high probability of stillbirth.

eugenie reich

Boston-based science writer Eugenie Reich

I wince at the very thought of it: Every day you keep the fetus in, you increase the child’s chances for a less-disabled life, but you also risk losing the pregnancy altogether. It’s quality of life vs. risk of loss. Every day is a roll of the dice, or maybe poker is the better metaphor: Do you hold or do you fold?

I don’t think it gives away too much to say that Eugenie chose to remain pregnant, and embarked on an exploration of the world of other women who made similar decisions — but who don’t usually talk or write about it except in anonymous online exchanges. Continue reading

Globe: C-Section Rates Reflect Hospital Subcultures

A doctor wonders how to stop the relentless rise in c-sections


Dr. Adam Wolfberg, an obstetrician at Tufts Medical Center, has an insider’s insight into the factors that make a hospital’s Cesarean-section rate high or low.

He does a wonderful weaving job in the latest Boston Globe magazine: from his own patient in a tricky delivery situation; to Cambridge Hospital, where the C-section rates are among the lowest in the state; to Holy Family Hospital in Methuen, where the rates are high. Some of the cultural and logistical factors that influence the rates may surprise you. What surprised me even more was this striking scene from a conference, given how much hand-wringing we tend to hear about C-section rates:

At a recent Las Vegas conference on obstetrical safety, some 125 members of the audience were asked to raise their hand to indicate their personal C-section rate. “Less than 15 percent?” the speaker asked. Two hands in the large auditorium went up. “Fifteen to 30 percent?” Half the hands were up. “More than 30 percent?” The rest. Then the speaker asked the room, “How many of you care?” No one raised a hand, and the room broke out in laughter.

 

 

First Live Birth Inside An MRI

I figure anything that makes me say “Ullp” out loud is worth posting…Fortunately, the video of the world’s first live birth inside an MRI scanner is really quite tasteful — and I’ve rarely seen such a good illustration of just how much of the mother’s body the baby takes up. This from cnet.com, and the full report is here:

Props to the woman in Germany who this morning became the first ever to give birth inside a magnetic-resonance imaging scanner.
Yes, the prototype scanner was built specifically for labor, and MRIs have been deemed quite safe. But the woman still had to give birth inside one, not to mention wear earmuffs to block out the high-frequency noise. (To protect the newborn’s hearing, the scanner was switched off as soon as the amniotic sac surrounding it opened.)
Woman and baby are both fine, according to gynecologist Ernst Beinder at Berlin’s Charité Hospital, who tells the Daily Mail that the birth was normal and the scanner captured all movements and processes throughout labor: “‘We can now see all the details we previously could only study with probes,” he says.