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A Scoping Review of Excessive Prenatal Ultrasonography as a Potential Risk Factor for Autism

Received: 1 September 2021    Accepted: 28 September 2021    Published: 28 October 2021
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Abstract

For the past several decades, abdominal/pelvic prenatal ultrasonography (P-USG) has been the most significant technology used in obstetrics. There has been a tremendous increase in use throughout the world and there have been many improvements in the technology used. However, there are aspects of the technology such as frequency, exposure time, thermal and cavitation exposure indices, and increased acoustic output of the ultrasonic waves that possibly could be harmful to the embryo/fetus. In particular, prolonged exposure may increase susceptibility to Autism Spectrum Disorder (ASD). Along with the increasing use of P-USG, there has been a similar increase in the incidence of ASD. The diagnosis of ASD has been found to be more common in geographic areas with a more affluent ethnicity, high socioeconomic status, and high parental education. These are also areas where prenatal ultrasonography is readily available and affordable. Given that there are biophysical risks from P-USG, especially in non-medical settings, P-USG may emerge as a possible risk factor for ASD. The past history of radiography provides a historical perspective: the predominant past opinion years ago was that exposure to X-rays during pregnancy caused no significant risk to a fetus. However, the association between X-ray exposure and childhood leukemia was only established 40 years after X-ray use began. This review focuses on the literature which supports the generation of the hypothesis that excessive P-USG usage may be a factor in the etiology of ASD.

Published in American Journal of Pediatrics (Volume 7, Issue 4)
DOI 10.11648/j.ajp.20210704.12
Page(s) 189-197
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Autism, Autistic Spectrum Disorder, Children, Behavior, Ultrasonography, Prenatal, Pregnancy

References
[1] Bertrand J, Mars A, Boyle C, Bove F, Yeargin-Allsopp M, Decoufle P. Prevalence of autism in a United States population: The Brick Township, New Jersey, investigation. Pediatrics 2001; 108: e1155–e1161.
[2] Donald I, McVicar J, Brown T. The investigation of abdominal masses by pulsed ultrasound. Lancet. 1958; 271: e1188-e1195.
[3] Bang J, Holm HH. Ultrasonics in the demonstration of fetal heart movements. Am J Obstet Gynecol. 1968; 102: e956-e960.
[4] Campbell S. A short history of sonography in obstetrics and gynaecology. Facts Views Vis Obgyn. 2013; 5: e213-e229.
[5] Sippel S, Muruganandan K, Levine A, Shah S. Review Article: use of ultrasound in the developing world. Int J Emerg Med. 2011; 4: e72-e83.
[6] Joy J, Cooke I, Love, M. Is ultrasound safe? Obstet Gynaecol. 2006; 8: e222-e227.
[7] Chen Z. Assessment of ultrasound field properties and the potential effects on cells [Master’s Thesis]. Stockholm, Sweden: Royal Institute of Technology; 2013. https://www.diva-portal.org/smash/get/diva2: 637933/FULLTEXT02.pdf.
[8] Pooh RK, Maeda K, Kurjak A, Sen C, Ebrashy A, Adra A, Dayyabu AL, Wataganara T, de Sá RA, Stanojevic M. 3D/4D sonography - any safety problem. J Perinat Med. 2016; 44 (2): 125-129.
[9] American Institute of Ultrasound in Medicine: Standard for real-time display of thermal and mechanical indices on diagnostic ultrasound equipment., Laurel, MD, 1992 and National Electrical Manufacturers Association, Rosslyn, VA. www.nema.org/Standards/Pages/Standard-for-Real-Time-Display-of-Thermal-and-Mechanical-Acoustic-Output-Indices-on-Diagnostic-Ultrasound-Equipment.aspx.
[10] Safety Group of the British Medical Ultrasound Society. Guidelines for the safe use of diagnostic ultrasound equipment. Ultrasound. 2010; 18: e52-e59.
[11] Abramowicz, JS. First-Trimester Ultrasound: A Comprehensive Guide; Detroit MI, Springer, 2016.
[12] Food and Drug Administration (FDA). 510 (k) Guide for Measuring and Reporting Acoustic Output of Diagnostic Ultrasound Medical Devices. Rockville, MD: FDA Center for Devices and Radiological Health; 1985. https://www.fda.gov/ucm/groups/fdagov-public/@fdagovmeddev-gen/documents/document/ucm578118.pdf.
[13] Food and Drug Administration (FDA). Revised 510 (k) Diagnostic Ultrasound Guidance for 1993. Rockville, MD: FDA Center for Devices and Radiological Health; 1993.
[14] Stratmeyer ME, Greenleaf JF, Dalecki D, Salvesen KA. Fetal ultrasound: mechanical effects. J Ultrasound Med. 2008; 27: e597-e605.
[15] Henderson J, Wilson K, Jago JR, et al. A survey of the acoustic outputs of diagnostic ultrasound equipment in current clinical use. Ultrasound Med Biol. 1995; 21: e699-e7051.
[16] Sheiner E, Hackmon R, Shoham-Vardi I, et al. A comparison between acoustic output indices in 2D and 3D/4D ultrasound in obstetrics. Ultrasound Obstet Gynecol. 2007; 29 (3) e326–e328. doi: 10.1002/uog.3933. 2007; 29 (3): e326-e328. doi: 10.7863/jum.2005.24.12.1587. PMID: 16301716.
[17] Sheiner E, Shoham-Vardi I, Pombar X, Hussey MJ, Strassner HT, Abramowicz JS. An increased thermal index can be achieved when performing Doppler studies in obstetric sonography. J Ultrasound Med. 2007; 26 (1): e71-e76.
[18] Kanner L. Autistic disturbances of affective contact. Nervous Child. 1943; 2: 217-250.
[19] Asperger H. Die autistisehen psychopathen in kindesalter. Arch Psych Nervenkrankh. 1944; 117: e76-e136. In German.
[20] Lotter V. Epidemiology of autistic conditions in young children. Soc Psychiatry. 1966; 1: 124-135.
[21] Treffert D. Epidemiology of infantile autism. Arch Gen Psychiatry. 1970; 22: e431-e438.
[22] American Psychiatric Association. (APA). Diagnostic and Statistical Manual of Mental Disorders, third edition. Washington, DC: APA. 1980.
[23] American Psychiatric Association. (APA). Diagnostic and Statistical Manual of Mental Disorders, fourth edition. Washington, DC: APA. 1994. http://displus.sk/DSM/subory/dsm4.pdf.
[24] American Psychiatric Association. (APA). Diagnostic and Statistical Manual of Mental Disorders, fourth edition, text rev. Washington, DC: APA 2000. https://www.psychiatry.org/psychiatrists/practice/dsm.
[25] American Psychiatric Association. (APA). Diagnostic and Statistical Manual of Mental Disorders, fifth edition. Washington, DC: APA 2013. https://www.psy.
[26] World Health Organization. International Classification of Disease (ICD-10) Classification of Mental and Behavioural Disorders: "Blue Book“(Clinical Descriptions and Diagnostic Guidelines). https://www.who.int/classifications/icd/en/bluebook.pdf?ua=1.
[27] Reed GM. Toward ICD-11: improving the clinical utility of WHO’s International Classification of mental disorders. Prof Psychol Res Pract. 2010; 41: e457-e464.
[28] Elsabbagh M, Divan G, Koh YJ, et al. Global prevalence of autism and other pervasive developmental disorders. Autism Res. 2012, 5: e160–e179.
[29] Al-Ansari AM, Ahmed MM. Epidemiology of autistic disorder in Bahrain: Prevalence and obstetric and familial characteristics. Mediterr Health J. 2013; 19: e769- e774.
[30] Bryson SE, Clark BS, Smith IM. First report of a Canadian epidemiological study of autistic syndromes. J Child Psychol Psychiatry. 1988; 29 (4): e433-e445.
[31] Lazoff TL, Piperni T, Fombonne E. Prevalence of pervasive developmental disorders among children at the English Montreal School Board. Can J Psychiatry. 2010; 55: e715e720.
[32] Public Health Agency of Canada. 2018 Report of the National Autism Spectrum Disorder (ASD) Surveillance System. Autism Prevalence among Children and Youth in Canada. 2018. https://www.canada.ca/en/public-health/services/publications/diseasesconditions/infographic-autism-spectrum-disorder-children-youth-canada-2018.html.
[33] Wang F, Lu L, Wang SB, Zhang L, et al. The prevalence of autism spectrum disorders in China: a comprehensive meta-analysis. Int J Biol Sci. 2018 May 12; 14 (7): e717-e725.
[34] Van Bakel MM, Delobel-Ayoub M, Cans C, et al. Low but increasing prevalence of autism spectrum disorders in a French area from register-based data. J Autism Dev Disord. 2015 Oct; 45 (10): e3255-e3261.
[35] Rudra A, Belmonte MK, Soni PK, Banerjee S, Mukerji S, Chakrabarti B. Prevalence of autism spectrum disorder and autistic symptoms in a school-based cohort of children in Kolkata, India. Autism Res. 2017; 10 (10): e1597-e1605.
[36] Mahajnah M, Sharkia R, Shalabe H, et al. Clinical characteristics of autism spectrum disorder in Israel: impact of ethnic and social diversities. Biomed Res Int. 2015; 2015: e962093.
[37] Hoshino Y, Kumashiro H, Yashima Y, Tachibana R, Watanabe M. The epidemiological study of autism in Fukushima-ken. Folia Psychiatr Neurol Jpn. 1982; 36: e115-e124.
[38] Kawamura Y, Takahashi O, Ishii T. Reevaluating the incidence of pervasive developmental disorders: impact of elevated rates of detection through implementation of an integrated system of screening in Toyota, Japan. Psychiatry Clin Neurosci. 2008; 62: e152-e159.
[39] Kim YS, Fombonne E, Koh YJ, Kim SJ, Cheon KA, Leventhal BL. A comparison of DSM- IV pervasive developmental disorder and DSM-5 autism spectrum disorder prevalence in an epidemiologic sample. J Am Acad Child Adolesc Psychiatry. 2014; 53 (5): e500-e508.
[40] van der Ven E, Termorshuizen F, Laan W, Breetvelt EJ, van Os J, Selten JP. An incidence study of diagnosed autism-spectrum disorders among immigrants to the Netherlands. Acta Psychiatr Scand. 2013 Jul; 128 (1): e54-e60. Epub 2012 Dec 9.
[41] Al-Farsi YM, Al-Sharbati MM, Al-Farsi OA, Al-Shafaee MS, Brooks DR, Waly MI. Brief report: prevalence of autistic spectrum disorders in the Sultanate of Oman. J Autism Dev Disord. 2011; 41: e821-e825.
[42] Al-Salehi SM, Al-Hifthy EH, Ghaziuddin M. Autism in Saudi Arabia: presentation, clinical correlates, and comorbidity. Transcult Psychiatry. 2009; 46: e340–e347.
[43] Faheem M, Mathew S, Al Qahtani M. et al. Autism spectrum disorder: knowledge, attitude, and awareness in Jeddah, Kingdom of Saudi Arabia. BMC Genomics. 2016; 17 (6): e62.
[44] Salhia HO, Al-Nasser LA, Taher LS, Al-Khathaami AM, El-Metwally AA. Systematic review of the epidemiology of autism in Arab Gulf countries. Neurosciences. 2014; 19: e291e296.
[45] Steffenburg S, Gillberg C. Autism and autistic-like conditions in Swedish rural and urban areas: a population study. Br J Psychiatry. 1986; 149 (1): e81-e87.
[46] Gillberg C, Cederlund M, Lamberg K, Zeijlon L. Brief report: "the autism epidemic". The registered prevalence of autism in a Swedish urban area. J Autism Dev Disord. 2006; 36: e429-e435.
[47] Eapen V, Mabrouk AA, Zoubeidi T, Yunis F. Prevalence of pervasive developmental disorders in preschool children in the UAE. J Trop Pediatr. 2007; 53: e202-e205.
[48] Baird G, Simonoff E, Pickles A, et al. Prevalence of disorders of the autism spectrum in a population cohort of children in South Thames: the special needs and autism project (SNAP). Lancet. 2006; 368: e210-e215.
[49] Centers for Disease Control and Prevention (CDC). Prevalence of autism spectrum disorders—Autism and Developmental Disabilities Monitoring Network, United States, 2006. MMWR Surveill Summ. 2009; 58 (SS10): e1-e20.
[50] Christensen DL, Braun KVN, Baio J, et al. Prevalence and characteristics of autism spectrum disorder among children aged 8 years—Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2012. MMWR Surveill Summ. 2018; 65 (13): e1-e23.
[51] Baio J, Wiggins L, Christensen DL, et al. Prevalence of autism spectrum disorder among children aged 8 years — Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2014. MMWR Surveill Summ 2018; 67 (No. SS-6): e1–e23.
[52] Barbaresi WJ, Colligan RC, Weaver AL, Katusic SK. The incidence of clinically diagnosed versus research-identified autism in Olmsted County, Minnesota, 1976-1997: results from a retrospective, population-based study. J Autism Dev Disord. 2009; 39: e464-e470.
[53] Latif AH, Williams WR. Diagnostic trends in autistic spectrum disorders in the South Wales valleys. Autism. 2007; 11: e479-e487.
[54] Baxter AJ, Brugha TS, Erskine HE, Scheurer RW, Vos T, Scott JG. The epidemiology and global burden of autism spectrum disorders. Psychol Med. 2015; 45 (3): e601-e613.
[55] Vos T, Abajobir AA, Abate KH, et al. Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet; 2017; 390: e1211-e1259.
[56] Kogan MD, Schieve LA, et al. Prevalence of parent-reported diagnosis of autism spectrum disorder among children in the US, 2007. Pediatrics. 2009; 124: e1395- e1403.
[57] Kogan, MD, Vladutiu CJ, Schieve LA et al. The Prevalence of parent-reported autism spectrum disorder among US children. Pediatrics. 2018; 142 (6): pii: e20174161.
[58] Thomas P, Zahorodny W, Peng B, et al. The association of autism diagnosis with socioeconomic status. Autism. 2012; 16: e201-e213.
[59] Durkin MS, Maenner MJ, Meaney FJ, et al. Socioeconomic inequality in the prevalence of autism spectrum disorder: evidence from a U.S. cross-sectional study. PloS One. 2010; 5 e11551.
[60] Van Meter KC, Christiansen LE, Delwiche LD, Azari R, Carpenter TE, Hertz-Picciotto I. Geographic distribution of autism in California: a retrospective birth cohort. Autism Res. 2010; 3: e19-e29.
[61] Autism and Developmental Disabilities Monitoring Network Surveillance Year 2002 Principal Investigators; Centers for Disease Control and Prevention. Prevalence of autism spectrum disorders—autism and developmental disabilities monitoring network, 14 sites, United States, 2002. MMWR Surveill Summ. 2007; 56: e12-e28.
[62] McKinlay A. The ultrasonic boom—focus on health and safety. Prog Biophys Mol Biol. 2007; 93: e1-e2.
[63] Hertz-Picciotto I, Delwiche L. The rise in autism and the role of age at diagnosis. Epidemiology. 2009; 20 (1): e84-e90.
[64] Lai MC, Baron-Cohen S. Identifying the lost generation of adults with autism spectrum conditions. Lancet Psychiatry. 2015; 2: e1013-e1027.
[65] Grether JK, Li SX, Yoshida CK., Croen LA. Antenatal ultrasound, and risk of autism spectrum disorders. J Autism Dev Disord. 2010; 40: 238-245.
[66] Stoch YK, Williams CJ, Granich J, et al. Are prenatal ultrasound scans associated with the autism phenotype? Follow-up of a randomised controlled trial. J Autism Dev Disord. 2012; 42: 2693-2701.
[67] Carlsson LH, Saltvedt S, Anderlid BM, et al. Prenatal ultrasound and childhood autism: long-term follow-up after a randomized controlled trial of first- vs second-trimester ultrasound. Ultrasound Obstet Gynecol. 2016; 48: e285-e288.
[68] World Federation for Ultrasound in Medicine and Biology/International Society of Ultrasound in Obstetrics and Gynecology (WFUMB/ISUOG). WFUMB/ISUOG statement on the safe use of Doppler ultrasound during 11–14-week scans (or earlier in pregnancy). Ultrasound Med Biol 2013; 39 (3): e373.
[69] American Institute of Ultrasound in Medicine. As low as reasonably achievable (ALARA) principle; 2014. http://www.auim.org/publications/viewStatement.aspx?id=39.
[70] ACOG Practice Bulletin No. 175: Ultrasound in pregnancy. Obstet Gynecol. 2016; 128 (6): e241-e256.
[71] ACOG Committee on Obstetric Practice. ACOG Committee Opinion No. 723, Guidelines for diagnostic imaging during pregnancy and lactation. Obstet Gynecol 2017; 130 (4): e210-e216.
[72] American Institute of Ultrasound in Medicine. AIUM-ACR-ACOG-SMFM-SRU Practice parameter for the performance of standard diagnostic obstetric ultrasound examinations. J Ultrasound Med. 2018; 37 (11): e13-e24.
[73] Casanova, MF. The neuropathology of autism. Brain Pathol. 2007; 17: e422-e433.
[74] Williams EL, Casanova MF. Potential teratogenic effects of ultrasound on corticogenesis: implications for autism. Med Hypotheses. 2010; 75: e53-e58.
[75] Webb SJ, Garrison MM, Bernier R, McClintic AM, King BH, Mourad PD. Severity of ASD symptoms and their correlation with the presence of copy number variations and exposure to first trimester ultrasound. Autism Res. 2017; 10: e472e484.
[76] Sharp AJ, Locke DP, McGrath SD, et al. Segmental duplications and copy-number variation in the Human Genome. Am J Hum Genet. 2005; 77: e78-e88.
[77] AIUM Bioeffects Committee. AIUM responds to autism study. http://www.aium.org/soundWaves/article.aspx?aId=965&iId=20160907.
[78] Abramowicz JS. Ultrasound and autism: association, link, or coincidence? J Ultrasound Med. 2012; 31 (8): e1261-e1269.
[79] Abramowicz JS. Benefits and risks of ultrasound in pregnancy. Semin Perinatol. 2013; 37 (5): e295-e300.
[80] Miller DL. Safety assurance in obstetrical ultrasound. Semin Ultrasound CT MR. 2008; 29 (2): e156-e164.
[81] Salvesen KÅ, Lees C. Ultrasound is not unsound, but safety is an issue. Ultrasound Obstet Gynecol. 2009; 33: 502-505.
[82] Kieler H, Cnattingius S, Haglund B, Palmgren J, Axelsson O. Sinistrality--a side-effect of prenatal sonography: a comparative study of young men. Epidemiology. 2001; 12: 618-623.
[83] Marinac-Dabic D, Krulewitch, CJ. Moore, RJ. The safety of prenatal ultrasound exposure in human studies. Epidemiology: 2002; 13 (3): eS19-eS22.
[84] Cibull SL. Harris GR, Nell DM. Trends in diagnostic ultrasound acoustic output from data reported to the US Food and Drug Administration for device indications that include fetal applications. J Ultrasound Med 2013; 32: e1921– e1932.
[85] Rosman NP, Vassar R, Doros G, et al. Association of prenatal ultrasonography and autism spectrum disorder. JAMA Pediatr. 2018; 172 (4): e336-e 344.
[86] Marsál K. The output display standard: has it missed its target. Ultrasound Obstet Gynecol. 2005: 25: e211-e214.
[87] SzaboTL, Lewin PA. Ultrasound Transducer Selection in Clinical Imaging Practice. J Ultrasound Med. 2013; 32 (4); e573-e582.
[88] Sheiner E, Shoham-Vardi I, Abramowicz JS. What do clinical users know regarding safety of ultrasound during pregnancy? JUltrasoundMed. 2007; 26: e319-e325.
[89] Piscaglia F, Tewelde AG, Righini R, Gianstefani A, Calliada F, Bolondi L. Knowledge of the bio-effects of ultrasound among physicians performing clinical ultrasonography: result a survey conducted by the Italian Society for Ultrasound in Medicine and Biology (SIUMB). J Ultrasound. 2009; 12 (1): e6-e11.
[90] Akhtar W, Arain MA, Ali A, et al. Ultrasound biosafety during pregnancy: What do operators know in developing world? National survey findings from Pakistan. J Ultrasound Med. 2011; 30: e981-e985.
[91] Wax JR, Cartin A, Pinette MG, Blackstone J. Nonmedical fetal ultrasound: knowledge and opinions of Maine obstetricians and radiologists. J Ultrasound Med. 2006; 25: e331-e335.
[92] Dowdy D. Keepsake ultrasound: taking another look. J Radiol Nurs. 2016; 35 (2): e119-e132.
[93] Barnett SB, Abramowicz JS, Ziskin MC, et al. WFUMB symposium on safety of nonmedical use of ultrasound. Ultrasound Med Biol. 2010; 36 (8): e1209-e1212.
[94] Raucher MS. What they mean by "good science": the medical community's response to boutique fetal ultrasounds. J Med Philos. 2009; 34 (6): e528-e544.
[95] Food and Drug Administration. Avoid fetal "keepsake" images, heartbeat monitors. 2016. https://www.fda.gov/ForConsumers/ConsumerUpdates/ucm095508.htm.
[96] European Committee for Medical Ultrasound Safety (ECMUS). Souvenir scanning statement 2006. http://www.efsumb.org/ecmus.
[97] Williams JG, Higgins JPT, Brayne CEG. Systematic review of prevalence studies of autism spectrum disorders. Arch Dis Child. 2006; 91: e8-e15.
[98] von Ehrenstein Ondine S, Ling Chenxiao, Cui Xin, Cockburn Myles, Park Andrew S, Yu Fei et al. Prenatal and infant exposure to ambient pesticides and autism spectrum disorder in children: population based case-control study BMJ 2019; 364: l962-1969.
[99] MacMahon B. Prenatal X-ray exposure and childhood cancer. J Natl Cancer Inst. 1962; 28: e1173-e1191.
[100] O’Keeffe DF, Abuhamad A. Obstetric ultrasound utilization in the United States: data from various health plans. Semin Perinatol. 2013; 37 (5): e292-e294.
[101] Ziskin MC, Morrissey J. Thermal thresholds for teratogenicity, reproduction, and development. Int J Hyperthermia. 2011; 27 (4): e374-e87.
[102] Fairbrother G, Burigo J, Sharon T, Song K. Prenatal screening for fetal aneuploidies with cell-free DNA in the general pregnancy population: a cost-effectiveness analysis. J Matern Fetal Neonatal Med. 2016; 29 (7): e1160-e1164.
[103] Flint K, Bottenus N, Bradway D, et al. An Automated ALARA Method for Ultrasound: An Obstetric Ultrasound Feasibility Study. J Ultrasound Med. 2020 Dec 2. doi: 10.1002/jum.15570. Epub ahead of print. PMID: 33289152.
[104] Knickmeyer RC, Gouttard S, Kang C, et al. A structural MRI study of human brain development from birth to 2 years. J Neurosci. 2008; 28: e12176-e12182.
[105] Ecker C. The neuroanatomy of autism spectrum disorder: an overview of structural neuroimaging findings and their translatability to the clinical setting. Autism. 2017; 21 (1): e18-e28.
[106] Courchesne E. Abnormal early brain development in autism. Mol Psychiatry. 2002; 7 (Suppl. 2): eS21-eS23.
[107] Hazlett HC, Poe M, Gerig G. Magnetic resonance imaging and head circumference study of brain size in autism: birth through age 2 years. Arch Gen Psychiatry. 2005; 62 (12): e1366-e1376.
[108] Courchesne E, Karns C, Davis HR, et al. Unusual brain growth patterns in early life in patients with autistic disorder: an MRI study. Neurology. 2001; 57: e245-e254.
[109] Courchesne E, Pierce K, Schumann CM et al. Mapping early brain development in autism. Neuron. 2007; 56 (2): e399-e416.
[110] Courchesne E, Mouton PR, Calhoun ME et al. Neuron number and size in prefrontal cortex of children with autism. JAMA. 2011; 306 (18): e2001-e2010.
[111] Lombardo MV, Moon HM, Su J, Palmer TD, Courchesne E, Pramparo T. Maternal immune activation dysregulation of the fetal brain transcriptome and relevance to the pathophysiology of autism spectrum disorder. Mol Psychiatry. 2017; 23 (4): e1001- e1013.
[112] COVID-19 Stats: COVID-19 Incidence, by Age Group — United States, March 1–November 14, 2020. MMWR Morb Mortal Wkly Rep 2021; 69: 1664. doi: http://dx.doi.org/10.15585/mmwr.mm695152a8external icon Fryer K, Delgado A, Foti T, Reid CN, Marshall J. Implementation of Obstetric Telehealth.
[113] During COVID-19 and Beyond. Matern Child Health J. 2020 Sep; 24 (9): 1104-1110. doi: 10.1007/s10995-020-02967-7. PMID: 32564248; PMCID: PMC7305486.
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    Hissa Moammar, Larry Desch, Rabi Sulayman. (2021). A Scoping Review of Excessive Prenatal Ultrasonography as a Potential Risk Factor for Autism. American Journal of Pediatrics, 7(4), 189-197. https://doi.org/10.11648/j.ajp.20210704.12

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    Hissa Moammar; Larry Desch; Rabi Sulayman. A Scoping Review of Excessive Prenatal Ultrasonography as a Potential Risk Factor for Autism. Am. J. Pediatr. 2021, 7(4), 189-197. doi: 10.11648/j.ajp.20210704.12

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    AMA Style

    Hissa Moammar, Larry Desch, Rabi Sulayman. A Scoping Review of Excessive Prenatal Ultrasonography as a Potential Risk Factor for Autism. Am J Pediatr. 2021;7(4):189-197. doi: 10.11648/j.ajp.20210704.12

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  • @article{10.11648/j.ajp.20210704.12,
      author = {Hissa Moammar and Larry Desch and Rabi Sulayman},
      title = {A Scoping Review of Excessive Prenatal Ultrasonography as a Potential Risk Factor for Autism},
      journal = {American Journal of Pediatrics},
      volume = {7},
      number = {4},
      pages = {189-197},
      doi = {10.11648/j.ajp.20210704.12},
      url = {https://doi.org/10.11648/j.ajp.20210704.12},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajp.20210704.12},
      abstract = {For the past several decades, abdominal/pelvic prenatal ultrasonography (P-USG) has been the most significant technology used in obstetrics. There has been a tremendous increase in use throughout the world and there have been many improvements in the technology used. However, there are aspects of the technology such as frequency, exposure time, thermal and cavitation exposure indices, and increased acoustic output of the ultrasonic waves that possibly could be harmful to the embryo/fetus. In particular, prolonged exposure may increase susceptibility to Autism Spectrum Disorder (ASD). Along with the increasing use of P-USG, there has been a similar increase in the incidence of ASD. The diagnosis of ASD has been found to be more common in geographic areas with a more affluent ethnicity, high socioeconomic status, and high parental education. These are also areas where prenatal ultrasonography is readily available and affordable. Given that there are biophysical risks from P-USG, especially in non-medical settings, P-USG may emerge as a possible risk factor for ASD. The past history of radiography provides a historical perspective: the predominant past opinion years ago was that exposure to X-rays during pregnancy caused no significant risk to a fetus. However, the association between X-ray exposure and childhood leukemia was only established 40 years after X-ray use began. This review focuses on the literature which supports the generation of the hypothesis that excessive P-USG usage may be a factor in the etiology of ASD.},
     year = {2021}
    }
    

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    AU  - Hissa Moammar
    AU  - Larry Desch
    AU  - Rabi Sulayman
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    DO  - 10.11648/j.ajp.20210704.12
    T2  - American Journal of Pediatrics
    JF  - American Journal of Pediatrics
    JO  - American Journal of Pediatrics
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    AB  - For the past several decades, abdominal/pelvic prenatal ultrasonography (P-USG) has been the most significant technology used in obstetrics. There has been a tremendous increase in use throughout the world and there have been many improvements in the technology used. However, there are aspects of the technology such as frequency, exposure time, thermal and cavitation exposure indices, and increased acoustic output of the ultrasonic waves that possibly could be harmful to the embryo/fetus. In particular, prolonged exposure may increase susceptibility to Autism Spectrum Disorder (ASD). Along with the increasing use of P-USG, there has been a similar increase in the incidence of ASD. The diagnosis of ASD has been found to be more common in geographic areas with a more affluent ethnicity, high socioeconomic status, and high parental education. These are also areas where prenatal ultrasonography is readily available and affordable. Given that there are biophysical risks from P-USG, especially in non-medical settings, P-USG may emerge as a possible risk factor for ASD. The past history of radiography provides a historical perspective: the predominant past opinion years ago was that exposure to X-rays during pregnancy caused no significant risk to a fetus. However, the association between X-ray exposure and childhood leukemia was only established 40 years after X-ray use began. This review focuses on the literature which supports the generation of the hypothesis that excessive P-USG usage may be a factor in the etiology of ASD.
    VL  - 7
    IS  - 4
    ER  - 

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Author Information
  • Research Department, King Salman Center for Disability Research, Riyadh, Saudi Arabia

  • Department of Pediatrics, Chicago Medical School, Chicago, the United States

  • Department of Pediatrics, Chicago Medical School, Chicago, the United States

  • Sections