Higher Steroid Hormone Levels in Pregnancy Can Cause Autism in Children

Researchers exploring the causes of autism have linked higher levels of steroid hormones in the womb during early fetal development to autism spectrum disorder.

These hormones, which play a key phase in brain development at three to four months of pregnancy, may also explain why the condition is far more common among males than females, they said.

But it was too early to say whether higher hormone levels were a cause of autism, the team wrote, and cautioned against hormone screening or treatment based on their preliminary findings.

Scientists at the University of Cambridge in Britain and Denmark's Statens Serum Institute analyzed hormone levels among nearly 20,000 stored samples of amniotic fluid, which surrounds the fetus in the uterus.

The team measured levels of four "sex" steroid hormones -- testosterone, progesterone, 17-alpha-hydroxy-progesterone and androstenedione -- which are known to play a role in brain development.

They also looked at a fifth hormone, cortisol, which is a marker of stress.

The researchers found higher hormone levels in the amniotic fluid in 128 males who were later diagnosed with autism spectrum disorder.

All autistic subgroups were found to have the signature: Asperger syndrome, classic autism or a category called unspecified pervasive developmental disorder.

"This is one of the earliest non-genetic biomarkers that has been identified in children who go on to develop autism," said Simon Baron-Cohen, a University of Cambridge professor.

"We previously knew that elevated prenatal testosterone is associated with slower social and language development, better attention to detail and more autistic traits.

"Now, for the first time, we have also shown that these steroid hormones are elevated in children clinically diagnosed with autism. Because some of these hormones are produced in much higher quantities in males than in females, this may help us explain why autism is more common in males."

It was not known what causes the higher steroid levels in the first place, and the team cautioned against using the findings as a tool to screen for autism.

Nor should drugs be used to block steroid hormones.

"This could have unwanted side effects and may have little to no effect," said Baron-Cohen.

Only males were tested in the first phase of research. The next step will be to see if a similar telltale exists for females.

"Steroid hormones are particularly important because they exert influence on the process of how instructions in the genetic code are translated into building proteins," co-researcher Craig Brierley said in an email exchange with AFP.

The study appeared in the journal Molecular Psychiatry.

The cause of autism, a complex neurodevelopmental disorder characterized by social withdrawal, is considered to be roughly split between genetic and environmental factors, according to a study last month in the Journal of the American Medical Association (JAMA).

Management of HIV in Pregnancy

HIV infection in young children most commonly arises as a result of mother-to-child transmission (MTCT). It is thought that only 1.5-2% of MTCT occurs transplacentally during pregnancy. The vast majority occurs due to maternofetal transmission of blood during parturition or postnatal breast-feeding.

All pregnant women are recommended screening for HIV infection, syphilis, hepatitis B and rubella in every pregnancy at their booking antenatal visit. If a woman declines an HIV test, this should be documented in the maternity notes, her reasons should be sensitively explored and screening offered again at around 28 weeks.

A negative maternal HIV test at booking does not preclude neonatal infection - maternal infection and seroconversion can occur at any time during pregnancy and lactation. This is well-documented in countries with a high prevalence of HIV and has been seen in the UK.

Risk of mother-to-child transmission (MTCT)

This is increased with:

    Higher levels of maternal viraemia.
    HIV core antigens.
    Lower maternal CD4 count.
    Primary HIV Infection occurring during pregnancy.
    Chorioamnionitis.
    Co-existing other sexually transmitted disease (and malaria - possibly).
    Invasive intrapartum procedures, eg fetal scalp electrodes, forceps, ventouse.
    Rupture of membranes (especially if delivery is more than 4 hours after the membranes ruptured).
    Vaginal delivery.
    Preterm birth
    Female babies more likely to be infected early (transplacental/perinatal routes).
    Advanced maternal age.
    The firstborn of twins (born to an HIV-infected mother).

Factors that decrease risk of transmission are:

    Higher levels of neutralising HIV antibody.
    Elective Caesarean section.
    Zidovudine (ZDV)
    Less invasive monitoring and intrapartum procedures.

Management

Mother-to-child transmission (MTCT) of HIV infection can be greatly reduced through early diagnosis of maternal HIV infection.

    Pregnant women should be offered screening for HIV early in pregnancy because appropriate antenatal interventions can reduce MTCT of HIV infection.
    Interventions to reduce MTCT of HIV during the antenatal period include antiretroviral therapy, elective Caesarean section delivery and avoidance of breast-feeding after delivery.
    These interventions can reduce the risk of mother-to child HIV transmission from 25-30% to less than 1%.
    All pregnant women who are HIV-positive should be screened and appropriately treated for genital infections during pregnancy. This should be done as early as possible in pregnancy and repeated at about 28 weeks.
    Presentation with symptoms or signs of pre-eclampsia, cholestasis or other signs of liver dysfunction during pregnancy may indicate drug toxicity, and early liaison with HIV physicians is essential.

Drug therapy

Women who require HIV treatment for their own health should take highly active antiretroviral therapy (HAART) and continue treatment postpartum. They may also require prophylaxis against pneumocystic pneumonia (PCP), depending on their CD4 lymphocyte count.

Women already taking HAART and/or PCP prophylaxis before pregnancy should not discontinue their medication.

    Antiretroviral therapy is given to prevent MTCT and to prevent maternal disease progression. The optimal regimen is determined on a case-by-case basis.
    Zidovudine (ZDV) is indicated for use in pregnancy for prevention of MTCT of HIV but single-agent ZDV therapy which does not suppress plasma viraemia to undetectable levels may allow the emergence of resistant virus.
    Potent combinations of three or more antiretroviral drugs (HAART) have now become the standard of care. Women with advanced HIV should be treated with a HAART regimen. The start of treatment should be deferred until after the first trimester, if possible, and should be continued after delivery.
    For women who do not require HIV treatment for their own health, HAART should be initiated between 20 and 28 weeks and discontinued at delivery. If they have a plasma viral load of less than 10,000 copies/ml and are prepared to be delivered by elective Caesarean section, an acceptable alternative is ZDV monotherapy initiated between 20 and 28 weeks, given orally, 250 mg twice daily, and intravenously started four hours before beginning the Caesarean section, continuing until the umbilical cord has been clamped. ZDV is usually administered orally to the neonate for four to six weeks.
    Combination antiretroviral therapy maximises the chance of preventing transmission and represents optimal therapy for the mother but may increase the risk of drug toxicity to the fetus.
    The use of antiretrovirals to reduce MTCT has resulted in resistant mutations and, in the Paediatric AIDS Clinical Trials Group Protocol, 15% of the women developed nevirapine-resistant mutations by 6 weeks' postpartum.

In sub-Saharan Africa, access to services is improving. In 2008, 45% of HIV-infected pregnant women received antiretroviral treatment compared with 9% in 2004. 

The Flu Shot Trifecta Protects Mom, Fetus and Infant

If you’re pregnant and haven’t gotten a flu shot it’s time to get one, says Geeta Swamy, who recommends pregnant women get the vaccine each year, whether their pregnancy falls before, during and even after the flu season peaks.

“Maternal immunizations protect the mother, but have an even greater potential impact on your baby,” says Swamy, a nationally recognized expert on immunizations during pregnancy. “It’s only one vaccine but it has three very important benefits – it protects the mom, it protects the fetus by preventing the risks of preterm delivery and low birth weight, and it protects the newborn before he or she is old enough to be vaccinated.”

While pregnant women are not at higher risk for getting the flu, they are more likely to suffer serious complications, Swamy says. Data show pregnant women are more likely to be hospitalized; and they have higher rates of pneumonia, respiratory complications and death related to the influenza infection.

The risks to the unborn child are just as severe.

“Babies who are exposed to influenza during the mother’s pregnancy may suffer from long-term implications,” says Swamy. “Even if mom is fine, there is some evidence to suggest that influenza exposure can lead to medical problems that include psychiatric disorders in the baby’s future.”

Swamy stresses that pregnant women who get a flu shot are not exposing their fetus to the infection. Rather, they are transferring antibodies against influenza to their unborn baby. That reduces the infant’s risk of contracting the flu before they are old enough to be vaccinated.

The ability to transfer antibodies in utero is also important for other infections like pertussis, also known as whooping cough, which has reached epidemic proportions in some states. “The Centers for Disease Control now recommends that women get the pertussis vaccine during each pregnancy to protect their unborn child,” says Swamy.

Since no immunization is perfect, pregnant women who have been vaccinated against the flu should continue to take precautions. “If you think you have been exposed, we can offer prophylactic treatment with anti-virals,” says Swamy. If you experience flu-like symptoms, including severe headache, malaise, fever and body aches, call your doctor.

“The ideal scenario is to obtain treatment within the first 48 hours,” says Swamy. That and a flu shot are your best lines of defense against a rampant infection that could have severe consequences for you and child. 

Genital Herpes

Genital herpes is caused by the agent called herpes simplex virus (HSV). There are two types of herpes virus:

I herpes virus type affects mainly skin and mucous coat of lips, eyes, nose (HSV-1)

II herpes virus type affects mucous coat of genital organs (HSV-2)

However, genital herpes may be developed under the influence of mixed infection of type I and type II.

Ways of transmission:
1. sexual contact with someone who has a genital HSV-2 infection;
2. genital oral contact;
3. autoinfection, when diseased person carries the virus from center of infection on uninfected parts of the body, for example, from face to genital organs;
4. vertical way of transmission is possible when during pregnancy occurs infection of baby from his mother (fetal infection) or during childbirth
5. domestic mode of transmission occurs extremely rarely and is completely excluded if the virus containing the secret dries.

The main source of infection in men is the urogenital tract, and in women - cervical canal.

Course

Infection with the herpes virus does not always cause manifestation of the disease, often it may have hidden character. In this case people do not know they have this virus disease, so they become source of infection for their sexual partner. A characteristic feature of herpes infection is duration of staying of the virus in the body (herpes virus may stay in the body whole life) and predisposition to aggravation. Undercooling, stress, overfatigue, infective disease (influenza, sore throat, respiratory viral infection) may cause aggravation of herpes.

Common manifestation: high temperature, headache, muscle pain, nausea.

Local manifestations occur in vulva area, vesical cervix area, urine. Typical sign is appearing of numerous small bladders with liquid, redness and edema of affected areas. When those bladders do burst, on their spots appear sores which do heal during 2-3 weeks. Along with bladder eruption and sore appearing patient can experience itch, pain, burning, lower abdomen severity.

Diagnostics of herpes infection is based on detecting the virus and its antibodies in the blood and in swabs from affected area.

Genital Herpes Treatment

Treatment takes quite long time. Genital herpes treatment is directed on stoppage of virus reproduction in human body and elevation of body defenses. Remedies acting directly on virus are not still found. Doctors prescribe such medications as Zovirax (Aciclovir), Neovir, specific zoster immunoglobulin. Ointments are used to shorten time for sores healing on affected areas.

In order to rise immunity doctors prescribe immunostimulants and vitamin and mineral complexes.

Taking Zovirax (Aciclovir) during several months helps to prevent recurrence of genital herpes.

Complications caused by herpes virus during pregnancy:

# prematurity or premature birth
# development of fetus abnormalities
# transplacental infection