Detección de los riesgos maternos perinatales en los trastornos generalizados del desarrollo

Abstract

Los trastornos generalizados del desarrollo (TGD), hacen referencia a un conjunto de alteraciones neuropsicológicas graves. Sus síntomas afectan a tres componentes del desarrollo: interacción social, lenguaje y comunicación e intereses, comportamientos y actividades restringidas y estereotipadas. Los TGD incluyen los siguientes trastornos: autismo, Rett, desintegrativo infantil, Asperger y el Trastorno generalizado del desarrollo no especificado. Su etiología resulta poco conocida y es un reto para la investigación actual. En los últimos años se ha acentuado la revisión de los problemas asociados con el embarazo y el parto. Diversas hipótesis sugieren que el embarazo, el parto e incluso las complicaciones neonatales, pueden actuar desde diversos frentes e incrementar el riesgo de autismo y de los demás TGD. El objetivo de esta investigación es estudiar la presencia de riesgos perinatales entre madres de hijos con TGD y madres de hijos sin TGD. En la investigación participaron un total de 259 madres. De ellas, 94 participaron como grupo experimental: todas tenían un hijo con un diagnóstico de TGD, según criterios del DSM-IV-TR (68 con trastorno autista, seis con trastorno de Asperger, uno con trastorno de Rett y 19 con TGD no especificado). Las mujeres restantes (165) fueron seleccionadas como grupo control y eran madres de infantes/niños con un desarrollo evolutivo normal. Para recoger la información sobre la presencia de riesgos perinatales, se utilizó el Cuestionario Materno de Riesgo Perinatal (CMRP). Este cuestionario es un autoinforme estructurado diseñado ad hoc que contempla, desde seis dimensiones ¾pregestacional, perigestacional, intraparto, neonatal, psicosocial y sociodemo-gráfica¾ la presencia o ausencia de 40 factores de riesgo pregestacionales y perigestacionales. Para cada factor valorado con el CMRP, se realizó un análisis de las puntuaciones medias y las desviaciones típicas, junto con un estudio de las frecuencias y los porcentajes resultantes. Asimismo, se efectuó una comparativa de las frecuencias y se utilizó el estadístico Chi-cuadrado de Pearson (c2), de los grupos experimental y control en cada uno de los reactivos del CMRP. En la dimensión pregestacional, se encontraron dos reactivos significativos en Chi-cuadrado: el número de abortos espontáneos anteriores y el uso de métodos anticonceptivos. En la dimensión perigestacional tres reactivos resultaron significativos: el consumo de fármacos y la presencia de edema durante el embarazo, así como también la ruptura prematura de la fuente. En la dimensión intraparto el grupo experimental mostró frecuencias más altas en aquellas situaciones que implican un mayor riesgo perinatal; un parto muy rápido o la tardanza de más de 12 horas en el mismo. En la dimensión neonatal la coloración azulada del neonato, indicativa de cianosis, fue superior en el grupo experimental. Por otra parte, la dimensión psicosocial ofreció dos reactivos significativos: el sexo deseado del bebé y el embarazo deseado. Por último, en la dimensión sociodemográfica, se identificaron dos reactivos importantes al comparar el grupo experimental con el grupo control, que fueron: la profesión de la madre y el sexo del bebé. Los resultados de esta investigación indican que existen diferencias significativas en niños con TGD que presentaron riesgos perinatales frente a otros con desarrollo evolutivo sin dificultades. Los niños con TGD muestran diferencias significativas comparados con otros niños sin TGD: tienen un desarrollo perinatal desigual, con una presencia significativamente distinta de riesgos perinatales. De esta forma, los riesgos físicos definen la presencia de riesgos perinatales en los TGD. Ahora bien, las dimensiones psicosocial y sociodemográfica deben también ser tomadas en cuenta

Pervasive Developmental Disorders (PDD) refer to a group of severe neuropsychologic alterations. Symptoms affect three development components: social-interaction skills, language and communication skills and a set of behaviours and activities that become restricted and stereotyped. PDDs include the following disorders: Autistic, Rett’s, Infantile Disintegrative, Asperger’s and Generalized Non-specific Development Disorder. Regarding to its unknown causes, several explanations have been gathered as a challenging task. They highlight the idea of generalised alterations in the Central Nervous System (CNS). However, the strongest thesis defines a multicausal etiology, with different factors associated to PDDs. Never the less, over the past few years, the review of problems associated with pregnancy and labour have been stressed. This perspective is complemented by other elements that point towards genetic alterations and CNS deficits as causes behind PDD. It has been suggested that pregnancy, labour and even neonatal complications can act on different fronts: increasing the risk of autism or any other PDD, or interacting along with genetic determinants to increase the potential risk at a critical moment in the perinatal development process. The goal of this paper is to study the presence of perinatal risk in mothers of children with and without PDD. A total of 259 mothers took part in the study; 95 were used as an experimental group: they all had a PDD-diagnosed child, according to DSM-IV-TR criteria (68 had autistic disorder, six had Asperger’s disorder, one had Rett’s disorder and 19 had non-specific PDD). The remaining 165 women had children with a normal evolutive development and were selected as a control group. In order to collect information about perinatal risk, a Maternal Perinatal Risk Questionnaire (MPRQ) was used. This is a structured and specifically-designed autoreport that evaluates the presence or absence of 40 pregestational and perigestational risk factors annalysed from six perspectives: pregestational, perigestational, intrapartum, neonatal, psychosocial and sociodemographic. For every factor evaluated in the MPRQ, an analysis of the average scores and typical deviations was made, along with a frequency and percentage study. Furthermore, a comparative of the frequencies in the control and experimental groups was carried out for every MPRQ item. By means of descriptive analysis, both groups were classified according to the children’s age and birth order, the mother’s age during pregnancy, current parent’s age and their educational and professional levels. When comparing the experimental group’s frequencies to those of the control group in the pregestational stage, two significative items were found in Chi-square: the number of previous spontaneous abortions and the use of contraceptive methods. As a result, the control group had fewer spontaneous abortions than the experimental group (10.9% and 22.4% respectively). The use of contraceptive methods previous to pregnancy described the control group’s superiority both for hormonal methods and intrauterine devices (IUD). The experimental group was defined by the absence of IUD and the scarce use of hormonal contraceptives (4.3%). In the perigestational dimension, the three significative items in Chi-square were: pharmacological consumption and presence of edema during pregnancy, and premature rupture of amniotic sac. Pharmacological consumption during pregnancy stresses the consumption of medicine or vitamines and iron in control group (81.2%), compared to the group of mothers of children with PDD (60.6%). The presence of gestational edema has been conclusively linked to the control group. As for the premature rupture of waters, a significantly higher presence of amniotic rupture was found in the experimental group compared to the control group. In the intrapartum dimension, the experimental group confirmed higher frequencies in situations that imply a higher perinatal risk such as: a very quick labour or one lasting over 12 hours. In the neonatal dimension, the control group showed with higher percentages (87.9%), the absence of blue coloration which would be indicative of cyanosis, when compared to the experimental group (79.8%). The psycho-social dimension included two significant items: the desired gender for the newborn and the desired pregnancy. The desired gender item confirmed that situations of happiness about finding out the baby’s gender were higher in the control group (68.4%) than in the experimental group. The desired pregnancy item proved that situations of desired pregnancy were higher in the control group (91.5%) compared to the experimental group (84.0%). Finally, in the socio-demographic dimension, two siginificative items were identified when comparing both groups: the mother’s profession and the baby’s gender. In one hand, regarding the mother’s profession, it was observed that mothers of PDD children were mainly found within home enviroment (37.2%) or unqualfied worker categories (18.1%). On the other hand, in the control group, the mothers who adscribed to the qualified professional category was notably higher (33.3%). Regarding the child’s gender, a higher risk is detected in males, at a proportion of 1 to 3. The results of this study showed that there are significative differences between PDD children who developed perinatal risks, compared to children who have a regular evolutive development. Children with PDD will thus show significant differences compared to non-PDD children: they have an unequal perinatal development and developed perinatal risks. Therefore, many risks are present in a higher measure in PDD children when compared to the control group. An innovative contribution is also made, by strongly suggesting that physical risks define the presence of perinatal risks in PDD. However, the psychosocial and sociodemographic dimensions must also be taken into account