Prenatal ultrasound and autism: What you need to know

September 23, 2016

I’ve seen reports about first trimester ultrasound exams being associated with autism. My obstetrician has ordered one. Should I be concerned?

Today’s “Got Questions?” response is from developmental pediatrician Daniel Coury, medical director of Autism Speaks Autism Treatment Network (AS-ATN). Dr. Coury is also the chief of developmental-behavioral pediatrics at Nationwide Children’s Hospital, in Columbus, Ohio.

Editor’s note: The following information is not meant to diagnose or treat and should not take the place of personal consultation, as appropriate, with a qualified healthcare professional and/or behavioral therapist.

Thank you for your question. You may be referring to the news headlines that followed a recent study about ultrasound and autism symptoms.

It’s unfortunate that splashy headlines often fail to put scientific findings in context. The new study found an association between ultrasound in a woman’s first trimester and the severity of autism symptoms in children who have a genetic predisposition to the disorder. The context that’s so important here is one of “correlation versus causation.” Two things – such as ultrasound in the first trimester and autism – can have a tendency to occur together (correlation) without one necessarily causing the other (causation).

In the wake of those recent headlines, experts have pointed out that a doctor ordering an ultrasound might be doing so because of concern about a medical condition that could affect the baby’s development. So the common denominator here may be a health problem during pregnancy – not necessarily the ultrasound itself.

Researchers have been studying ultrasound during pregnancy for more than 30 years. In that time, they’ve not found any consistent evidence of health risks associated with the procedure – in either the baby or the mother. However, it’s true that doctors are ordering prenatal ultrasound exams more frequently in recent years. More concerning to me, we’re now seeing them being done in routine pregnancies – when there is no known medical concern.

The recent study found a significant relationship between first trimester ultrasound and the severity of autism symptoms. But it looked only at children who had a genetic abnormality that predisposes to autism. In other words, it didn’t find that ultrasound caused autism. It suggested that the ultrasound might somehow increase the severity of autism symptoms in a child who is already predisposed to the disorder.

Or, as mentioned earlier, there may be some underlying common factor – such as concerns about the baby’s development – that increase the likelihood of both an ultrasound being ordered and the baby having a developmental problem such as autism.

In that context, you might want to discuss two things with your obstetrician:

  1. Is the ultrasound being ordered because the doctor has a medical concern about your pregnancy? If there is a valid reason for the ultrasound, the benefits are likely to outweigh any theoretical risk.
  2. Do you have reason to believe that autism runs in your family? For instance, do you already have a child on the autism spectrum? If that’s the case, you might want to ask your doctor whether there would be any harm in forgoing the ultrasound exam.

In conclusion, one study rarely answers our medical questions. For now, I think it’s premature to conclude that prenatal ultrasound causes harm. Rather, this issue deserves further study to clarify future recommendations.

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