Baby Movements in the Womb: Searching for Early Markers of Autism Spectrum Disorders

Background: To date, the early surveillance leading to an early intervention represents the only successful strategy to improve clinical outcomes in Autism Spectrum Disorder (ASD). The Italian network for early detection of ASD (NIDA) applies a clinical/biological standardized protocol for developmental surveillance in High Risk (HR, i.e. siblings of children with a diagnosis of ASD, preterm and small for gestational age newborns) and Low Risk infants (LR, i.e. siblings of typically developing children) with the aim of identifying early risk indexes of ASD. The NIDA network has recently characterized the early phases of motor development in HR infants detecting abnormalities in general movements in the first two weeks of age. Since fetal movements are considered to reflect the developing nervous system, it has been hypothesized that their examination could be a promising tool to identify early sign of ASD

Objectives: To develop novel multidisciplinary observational methods to identify fetal movements with a prognostic value for ASD.

Methods: The NIDA’s standardized protocol for developmental surveillance in HR and LR infants has been implemented with fetal movements screening. Data collected are going to be used to generate normative data and subsequently compare them to data collected on fetuses at risk of developing ASD. Multivariate statistical methods are fundamental to analyze fetal/newborn/infant data to detect early markers of ASD. This undergoing prospective study has been approved by Istituto Superiore di Sanità (ISS) ethic committee and complies with the guiding policies and principles for experimental procedures endorsed by the National Institutes of Health.

Results: The fetal screening standard operative procedures (SOPs) have been defined in collaboration with a child psychiatrist expert on infant movement assessment and with a gynecologist certified by the Fetal Medicine Foundation. First and second trimester ultrasound (US) examinations last ten minutes including five minutes of two-dimensional US followed by five minutes of four-dimensional US. The US probe view approaches the entire fetus or alternatively focuses on the upper torso of the body. One hour of cardio-tocographic recording occurs in the third trimester. Fetal movements are classified into different activities including general movements. The fetal biometric data are also detected across trimesters.

Conclusions: The NIDA project is actually monitoring the neurodevelopment of 70 HR and 75 LR infants. It has been expected that fetal US screening may be helpful in detecting predictive and/or prognostic markers of ASD.