Issue link: http://cp.revolio.com/i/855118
doeS LAbor InductIon cAuSe AutISM? A recently published paper associates labor induc on and augmenta on (the use of Pitocin to speed up a stalled or slow labor, which I will discuss in a subsequent ar cle) with increased risk of au sm. The large study looked at 625,042 live births linked with school records, and included more than 5,500 children with documented au sm. Compared with children born to mothers who received neither labor induc on nor augmenta on, children born to mothers who were induced and augmented, induced only, or augmented only had higher rates of au sm a er controlling for factors such as socioeconomic status, maternal health, and pregnancy-related events and condi ons. Male children were more likely to have au sm. One possible explana on for the rela onship between au sm and induc on is through exposure to exogenous oxytocin. Approximately 50% to 70% of women who undergo labor induc on receive Pitocin which is a synthe c oxytocin. Biologically, oxytocin signaling plays important roles influencing social behavior and cogni ve func on. Exposure during labor induc on or in labor may have a yet uniden fied gene c or epigene c effect. While the jury is s ll out on the associa on between au sm and induc on, which is most likely caused by mul ple factors in gene cally vulnerable children, it is interes ng to note that the increase in labor induc on in the past 2 decades has paralleled the increase in au sm rates. It should at least give us further pause to avoid unnecessary induc on and augmenta on, and treat it as a medical interven on with poten ally serious consequences, rather than something to be done rou nely or elec vely. the Myth of the too bIg bAby: When IS LAbor InductIon truLy neceSSAry? Medical indica ons for labor induc on include any medical circumstance in which you or baby is safer with baby out than in. These include preeclampsia, eclampsia, HELLP syndrome, diabetes, fetal growth restric on, infec on of the amnio c membranes (called chorioamnioni s), and placental abrup on. Surprisingly, given its prevalence, there is a paucity of high- quality evidence proving the benefits of induc on for specific medical and pregnancy condi ons. However, the above indica ons are generally very legit. Pregnancy with twins and mul ple babies might be an indica on for induc on in some cases, but should be evaluated individually based on the health of mom and the babies. Induc on for convenience-sake is never a medical indica on and is best avoided. One of the most common reasons for induc on is going past your due date, par cularly if the pregnancy gets to 1 week past due. At this point, you're also probably sick and red of being pregnant, so may readily agree when an indica on is proposed. There is evidence of a small increase in s llbirth in pregnancies between 41 and 42 weeks and another small increase between 42 and 43 weeks. However, between 41 and 42 week's gesta on it would take 527 induc ons to prevent one s llbirth. That's a lot of induc ons, and most women, le to the natural course of pregnancy, will go into labor by 41 weeks. The good news is that pooled data from a lot of studies show that ge ng induced a er 41 week's gesta on does not increase the risk of cesarean sec on compared with a wait and watch a tude. Another common jus fica on is that "the baby is ge ng too big, so we should induce now." The reality is that ultrasound sizing is only as accurate as the person doing the ultrasound, and even with highly skilled docs, midwives, and techs, there is a wide margin of error – o en erring with baby being on the larger side. And many women can give birth to babies weighing 8, 9, and 10 pounds without a problem. Even first babies. The hormones of late pregnancy and the design of the pelvis ingeniously allows the pelvis to "give" to accommodate the baby's head. So, unless mom is diabe c leading to an excessively large baby as a result, and other complica ons are arising, baby's size alone is not usually a good reason for induc on and as discussed earlier, inducing early can lead to risk of prematurity. Increased and regular monitoring of the baby with ultrasound to measure amnio c fluid and non-stress tes ng is commonly recommended once pregnancies reach 40 weeks and a few days. However, there is really no evidence for any specific type of monitoring improving outcomes for mom or baby. If any problems arise with baby's heart rate or there is too li le amnio c fluid, induc on in the hospital is recommended for op mal safety. Page 46 | Abby's Magazine - www.AbbysMag.com