Preconception: Reflections from an Autism Mom

Jennifer Elrod, mother of a toddler boy who is in the process of healing from mild autistic symptoms, speech delay and gross motor delay, tells us about the importance of preconception in this blog post.

As the mother of a toddler who has developmental delays, symptoms of autism, and signs of mitochondrial dysfunction, when I look back at the year before I became pregnant, I have a list of “I wish I had dones” and “I wish I had knowns”. Many of the items on those lists can probably be dismissed. But even after weeding out the less rational fears and doubts, a few things remain. These remaining items can be dismissed on the basis of “don’t feel guilty” or “move forward”. But they can’t be dismissed on logical grounds as opposed to psychological grounds.

My goal in looking back is to help somebody else. I have seen the women in the online forums asking other women what they wish they had known. This is for them. I can’t prove that any of these things contributed to Wyatt’s issues. But all of these things fall under the category of having a no-brainer risk benefit ratio.

In terms of preconception, it is riskier not to take the preventive measures I wish I had taken, than it is to do these things.

Mercury Amalgam Dental Fillings

My first mistake: I got my teeth cleaned, but I didn’t have my mercury amalgam dental fillings removed. The first thing was recommended in the guides I read. The second thing was not. I have eight fillings. I have a vague memory of one of them chipping off when I was in my teens. Removing these dental fillings would have been a better use of my money than buying a crib that was never used at all during my son’s first year of life – other than as a very expensive storage area for toys and clothes.

The time to get fillings removed is prior to conception. That gives the body time to get rid of the mercury that will be in circulation for a while after the removal. The removal itself will stir up more mercury temporarily. Pregnancy is not to the time to do it, but a pregnant woman can still take extra selenium, which binds with mercury.

Group B Strep

I did not learn until my third trimester that I had Group B Strep and that I would require an antibiotic IV to constantly drip into my blood throughout my thirty-six hour labor. I did not learn until Wyatt was a toddler just what the implications of my gut dysbiosis were. It meant that Wyatt, when he passed through my birth canal, got his sterile newborn gut colonized with whatever opportunistic pathogens the antibiotics did not kill. They had thirty-six hours to spread and fill the emtpy niches that were left in my gut.

I’m certain that Candida albicans was one of those pathogens. Other possibilities include Clostridia and other nasties that need the big guns to kill them and only flourish more when a penicillin-type antibiotic kills off their competitors in the gut.

Candida Albicans

Candida albicans, a yeast that is in everybody’s gut but that can overgrow and assume a fungal form under the right conditions, has come to light as a huge problem for both Wyatt and myself. I have learned that it is responsible for the agony I felt holding still waiting for him to fall asleep at my breast when he was a baby. He would awaken if I moved, but I felt like I had itches and restless energies in my arms and legs, and I could temporarily alleviate these feelings by moving. Sometimes after waiting for twenty minutes, I would twitch, and he would fuss, and I would have to start the process all over again. And I’d have to hold still even longer. But it didn’t even begin there.

That feeling goes way back to my first trimester of pregnancy, when I would have agonizing restless leg syndrome at my desk every afternoon for a while after eating lunch. Whenever those sensations come back, I know my Candida is getting out of the control again.

Since then, I have learned many things about Candida. Now I know that progesterone, which increases several-fold during the first trimester, also feeds Candida. Now I know that when Wyatt is having a yeast flare, he is wakeful at night, but after his yeast is back under control, he sleeps better than he ever did in his life.

Candida is not the only factor I have learned affects his sleep, but it is up there in the top five factors. Now I know that when Wyatt is having a yeast flare, he stares into space a lot and acts nearly deaf.

I look back on the days and nights of his napping and sleeping patterns of babyhood, when his best sleep habits were during his first three weeks of life, and he only got worse as he got older, and I wonder how much easier and more fun it all could have been if I had gotten my gut dysbiosis under control before I conceived him.

I look back on the months of trying to teach him signs, before he could talk, and the way he would just stare blankly when I tried to prompt him. I wonder how much faster he could have learned to sign.

Healing Gut Dysbiosis

What would I have done to heal my gut and make my birth canal a more hospitable place for my infant to pass through on his way out?  I would have gone on a diet such as Specific Carbohydrate Diet, GAPS diet or Body Ecology Diet. I would have consumed yogurt, kefir and kombucha. I would have taken anti-fungals such as grapefruit seed oil or caprylic acid.  I would have asked my OB/gyn for a Group B Strep test before conception.

Restoring the inner ecosystem of the gut to optimal health is a subject too large for this article, but the links I have provided to the three diets I mention are a good place to begin research.

Folic Acid vs. Folinic Acid

So, what else would I have done, besides healing my gut of its dysbiosis and removing my mercury amalgam dental fillings? I would have taken folinic acid, a more bio-available form of  folic acid. Not everybody’s body makes sufficient quantities of the enzyme needed to convert folic acid into its active forms.

I try almost every supplement I give Wyatt before I give it to him, and now I know that I am actually mildly depressed when I do not take folinic acid. I was used to feeling that way for so long that I did not even realize I felt that way, until I felt better.  Wyatt, in turn, has fixations on lights and lacks interest in most toys, without this supplement.

If it is true of both of us now that we do better on a folinic acid supplement, what was true of my body while I was pregnant and before I conceived? I suspect that the folic acid I took during that time did not do Wyatt any good. It seems to me that it is safer for women to take folinic acid rather than folic acid because most have no clue if their bodies are unable to properly utilize folic acid.

Iron Levels

I would also have had my iron levels checked before conception, and unless they were very high above the borderline, I would have taken measures to get them up. Even if they were okay, if they were only marginal, I would have found a good way to supplement. I probably would have eaten organic liver once a week or something like that, since an iron supplement would most likely have worked at cross-purposes to my other concern of healing my gut.

My iron was low during my third trimester, and Wyatt’s iron levels in turn were low when he was ten months old. I gave him iron drops, only to learn later that he has mitochondrial dysfunction and that iron supplements damage the mitochondria. That’s in addition to iron feeding pathogenic forms of bacteria in the gut. While he was on the iron drops, he had frequent and incredibly smelly farts, and his bowel movements contained lots of black flecks that were metallic looking and difficult to wipe off his skin.

Genetic Counseling

Last of all, I would have gotten some genetic testing done. I strongly suspect that Wyatt has a fatty acid oxidation disorder (FOD), and this is something that can be screened for in newborns.

He is not yet diagnosed, but he has all the signs of it. He has low tone and low energy that both worsen on a diet that is too high in fat and too low in carbs. FOD individuals have trouble metabolizing fat. Their bodies do not naturally make enough carnitine to overcome their genetic defect, but a carnitine supplement can help them use fat for energy and dispose of toxic fat metabolites that otherwise accumulate.

FOD babies are an exception to “breast is best” at least during their first few days of life, before the milk comes in. They do better if they get formula, in addition to colostrum, until the milk comes in. And if they receive a carnitine supplement from babyhood, they can avoid developmental delays.

Genetic testing could have alerted me if both my husband and I are carriers of the recessive gene for FOD. Failing that, I could have had a newborn screening done for FOD. FODs are rare, but there are other genetic tests and genetic counseling that can be done. Genetic counseling is underutilized.

Some people just need to take more of certain nutrients to overcome their genetic susceptibilities, and sometimes it’s possible to test for that sort of thing. Chances are that if I had taken the preventive measures I just sketched out, that Wyatt might still have some issues, but they would not be as bad. As the infamous saying goes, genetics loads the gun, but environment pulls the trigger. For babies, the environment starts in their mothers’ bodies, before they are ever conceived.

If you don’t do the things I recommend, it does not mean that your child will have a neurological disorder, a developmental delay, or other problem. But what can it hurt? If nothing else, you will be healthier, and you could end up with an easier baby who hits developmental milestones faster.

Of course, I am only speaking from my own experience, and you should do your own research and consult with other women to come up for the best plan for you as an individual. I am sure that I have left out things about preconception that I did not experience but other mothers have.

Still Looking for Answers?

Visit the Epidemic Answers Practitioner Directory to find a practitioner near you.

Join us inside our online membership community for parents, Healing Together, where you’ll find even more healing resources, expert guidance, and a community to support you every step of your child’s healing journey.

Sources & References

Alemany, S., et al. Prenatal and postnatal exposure to acetaminophen in relation to autism spectrum and attention-deficit and hyperactivity symptoms in childhood: Meta-analysis in six European population-based cohorts. Eur J Epidemiol. 2021 Oct;36(10):993-1004.

Ang, E.S.B.C., Jr., et al. Prenatal exposure to ultrasound waves impacts neuronal migration in mice. Proc Natl Acad Sci U S A. 2006 Aug 22;103(34):12903-10.

Ashwin, D., et al. The impact a Mediterranean Diet in the third trimester of pregnancy has on neonatal body fat percentage. J Dev Orig Health Dis. 2022 Aug;13(4):500-507.

Atladóttir, H.Ó., et al. Association of family history of autoimmune diseases and autism spectrum disorders. Pediatrics. 2009 Aug;124(2):687-94.

Atladóttir, H.Ó., et al. Autism after infection, febrile episodes, and antibiotic use during pregnancy: an exploratory study. Pediatrics. 2012 Dec;130(6):e1447-54.

Avella-Garcia, C.B., et al. Acetaminophen use in pregnancy and neurodevelopment: attention function and autism spectrum symptoms. Int J Epidemiol. 2016 Dec 1;45(6):1987-1996.

Baker, B.H., et al. Association of Prenatal Acetaminophen Exposure Measured in Meconium With Risk of Attention-Deficit/Hyperactivity Disorder Mediated by Frontoparietal Network Brain Connectivity. JAMA Pediatrics. 2020 Sep 28;e203080.

Bauer, A.Z., et al. Prenatal paracetamol exposure and child neurodevelopment: A review. Horm Behav. 2018 May:101:125-147.

Brandalize, A.P.C., et al. Evaluation of C677T and A1298C polymorphisms of the MTHFR gene as maternal risk factors for Down syndrome and congenital heart defects. Am J Med Genet. 2009 Oct;149A(10):2080-7.

Chaparro, C.M., et al. Effect of timing of umbilical cord clamping on iron status in Mexican infants: a randomised controlled trial. Lancet. 2006 Jun 17;367(9527):1997-2004.

Choudhury, P., et al. Microorganisms of maternal periodontitis cause adverse pregnancy outcomes in gestational diabetic individuals: a preliminary observational report. Quintessence Int. 2022 Oct 21;53(10):850-857.

Cobb, C.M., et al. The oral microbiome and adverse pregnancy outcomes. Int J Womens Health. 2017 Aug 8;9:551-559.

Curran, E.A., et al. Research review: Birth by caesarean section and development of autism spectrum disorder and attentiondeficit/hyperactivity disorder: a systematic review and meta-analysis. J Child Psychol Psychiatry. 2015 May;56(5):500-8.

Darling, A.L., et al. Association between maternal vitamin D status in pregnancy and neurodevelopmental outcomes in childhood: results from the Avon Longitudinal Study of Parents and Children (ALSPAC). Br J Nutr 2017 Jun;117(12):1682-1692.

Davis, J.A., et al. Can Positive Mindsets Be Protective Against Stress and Isolation Experienced during the COVID-19 Pandemic? A Mixed Methods Approach to Understanding Emotional Health and Wellbeing Needs of Perinatal Women. Int J Environ Res Public Health. 2021 Jun 29;18(13):6958.

Davis. J.A., et al. Perinatal Women's Perspectives of, and Engagement in, Digital Emotional Well-Being Training: Mixed Methods Study. J Med Internet Res. 2023 Oct 17:25:e46852.

Davis. J.A., et al. Time-out for well-being: A mixed methods evaluation of attitudes and likelihood to engage in different types of online emotional well-being programmes in the perinatal period. Womens Health (Lond). 2023 Jan-Dec:19:17455057231184507.

Divarka, N., et al. Effect of maternal prebiotic supplementation on human milk immunological composition: Insights from the SYMBA study.
Pediatr Allergy Immunol. 2024 Sep;35(9):e14226.

D'Vaz, N., et al. The ORIGINS Project Biobank: A Collaborative Bio Resource for Investigating the Developmental Origins of Health and Disease. Int J Environ Res Public Health. 2023 Jul 4;20(13):6297.

Fezer, G.F., et al. Perinatal Features of Children with Autism Spectrum Disorder. Rev Paul Pediatr. 2017 Apr-Jun;35(2):130-135.

Finlay-Jones, A.J., et al. Comparing Web-Based Mindfulness With Loving-Kindness and Compassion Training for Promoting Well-Being in Pregnancy: Protocol for a Three-Arm Pilot Randomized Controlled Trial. JMIR Res Protoc. 2020 Oct 14;9(10):e19803.

Frisch, M., et al. Ritual circumcision and risk of autism spectrum disorder in 0- to 9-year-old boys: national cohort study in Denmark. J R Soc Med. 2015 Jul;108(7):266-79.

Gamez, C., et al. Lower Cord Blood IL-17 and IL-25, but Not Other Epithelial Cell-Derived Cytokines Are Associated with Atopic Dermatitis in Infancy. Int Arch Allergy Immunol. 2021;182(6):474-478.

Gardender, H., et al. Perinatal and neonatal risk factors for autism: a comprehensive meta-analysis. Pediatrics. 2011 Aug;128(2):344-55.

Glasson, E.J., et al. Perinatal factors and the development of autism: a population study. Arch Gen Psychiatry. 2004 Jun;61(6):618-27.

González-Valenzuela, M.J., et al. Exposure to synthetic oxytocin during delivery and its effect on psychomotor development. Dev Psychobiol. 2015 Dec;57(8):908-20.

Guo, D., et al. Association of maternal diabetes with attention deficit/hyperactivity disorder (ADHD) in offspring: A meta-analysis and review. Diabetes Res Clin Pract. 2020 Jul:165:108269.

Hamad, A.F., et al. Prenatal antibiotics exposure and the risk of autism spectrum disorders: A population-based cohort study. PLoS One. 2019 Aug 29;14(8):e0221921.

Hansen, J.B., et al. Prenatal exposure to bisphenol A and autistic- and ADHD-related symptoms in children aged 2 and5 years from the Odense Child Cohort. Environ Health. 2021 Mar 12;20(1):24.

Hantsoo, L., et al. Childhood adversity impact on gut microbiota and inflammatory response to stress during pregnancy. Brain Behav Immun. 2019 Jan:75:240-250.

Hertz-Picciotto, I., et al. Organophosphate exposures during pregnancy and child neurodevelopment: Recommendations for essential policy reforms. PLoS Med. 2018 Oct 24;15(10):e1002671.

Hertz-Picciotto, I., et al. Prenatal exposures to persistent and non-persistent organic compounds and effects on immune system development. Basic Clin Pharmacol Toxicol. 2008 Feb;102(2):146-54.

Hobbs, C.A., et al. Polymorphisms in Genes Involved in Folate Metabolism as Maternal Risk Factors for Down Syndrome. Am J Med Genet. 2000 Sep; 67(3): 623–630.

Hood, R., et al. "It helps and it doesn't help": maternal perspectives on how the use of smartphones and tablet computers influences parent-infant attachment. Ergonomics. 2024 Feb;67(2):148-167.

Hood, R., et al. The association of mobile touch screen device use with parent-child attachment: a systematic review. Ergonomics. 2021 Dec;64(12):1606-1622.

Hood, R., et al. 'There's good and bad': parent perspectives on the influence of mobile touch screen device use on prenatal attachment. Ergonomics. 2022 Dec;65(12):1593-1608.

Huang, R.C., et al. Feasibility of conducting an early pregnancy diet and lifestyle e-health intervention: the Pregnancy Lifestyle Activity Nutrition (PLAN) project. J Dev Orig Health Dis. 2020 Feb;11(1):58-70.

Hutton, E.K., et al. Late vs early clamping of the umbilical cord in full-term neonates: systematic review and meta-analysis of controlled trials. JAMA. 2007 Mar 21;297(11):1241-52.

Ibilola, O., et al. Environmental (Perinatal) risk factors of ADHD in a sibling control design study. Open Access Journal of Behavioural Science & Psychology. 2021 Feb 05;4(1).

Jois, R.S., et al. Do probiotics in pregnancy reduce the risk of group B streptococcal colonisation? J Paediatr Child Health. 2020 Sep;56(9):1468-1472.

Konkel, L. Phthalates and Autistic Traits: Exploring the Association between Prenatal Exposures and Child Behavior. Environ Health Perspec. 2020 Oct;128(10):104001.

Korpela, K., et al. Maternal Fecal Microbiota Transplantation in Cesarean-Born Infants Rapidly Restores Normal Gut Microbial Development: A Proof-of-Concept Study. Cell, 2020.

Kurth, L., et al. Perinatal Pitocin as an early ADHD biomarker: neurodevelopmental risk? J Atten Disord. 2011 Jul;15(5):423-31.

Langley, E.A., et al. High maternal choline consumption during pregnancy and nursing alleviates deficits in social interaction and improves anxiety-like behaviors in the BTBR T+Itpr3tf/J mouse model of autism. Behav Brain Res. 2015 Feb 1;278:210-20.

Lavie, M., et al. Paleolithic diet during pregnancy-A potential beneficial effect on metabolic indices and birth weight. Eur J Obstet Gynecol Reprod Biol. 2019 Nov;242:7-11.

Li, D.K., et al. A population-based prospective cohort study of personal exposure to magnetic fields during pregnancy and the risk of miscarriage. Epidemiology. 2002 Jan;13(1):9-20.

Lu, X., et al. Azithromycin exposure during pregnancy disturbs the fetal development and its characteristic of multi-organ toxicity. Life Sci. 2023 Sep 15:329:121985.

Lueth, A.J. Allostatic Load and Adverse Pregnancy Outcomes. Obstet Gynecol. 2022 Dec 1;140(6):974-982.

Lyall, K., et al. Prenatal Serum Concentrations of Brominated Flame Retardants and Autism Spectrum Disorder and Intellectual Disability in the Early Markers of Autism Study: A Population-Based Case-Control Study in California. Environ Health Perspect. 2017 Aug 30;125(8):087023.

Magalhães, J.Z., et al. Prenatal exposure to fipronil disturbs maternal aggressive behavior in rats. Neurotoxicol Teratol. Nov-Dec 2015;52(Pt A):11-6.

Malin, A.J., et al. Maternal Urinary Fluoride and Child Neurobehavior at Age 36 Months. JAMA Netw Open. 2024 May 1;7(5):e2411987.

Martínez-Frías, M.L., et al. Maternal polymorphisms 677C-T and 1298A-C of MTHFR, and 66A-G MTRR genes: is there any relationship between polymorphisms of the folate pathway, maternal homocysteine levels, and the risk for having a child with Down syndrome? Am J Med Genet. 2006 May 1;140(9):987-97.

Mercer, J.S., et al. The Effects of Delayed Cord Clamping on 12-Month Brain Myelin Content and Neurodevelopment: A Randomized Controlled Trial. Am J Perinatol. 2022 Jan;39(1):37-44.

Muanda, F.T., et al. Use of antibiotics during pregnancy and the risk of major congenital malformations: a population based cohort study. Br J Clin Pharmacol. 2017 Nov;83(11):2557-2571.

Modabbernia, A., et al. Apgar score and risk of autism. Eur J Epidemiol. 2018 Oct 5.

Mulder, E.J.H., et al. Prenatal maternal stress: effects on pregnancy and the (unborn) child. Early Hum Dev. 2002 Dec;70(1-2):3-14.

Nguyen, L.D.., et al. Women's holistic self-care behaviors during pregnancy and associations with psychological well-being: implications for maternal care facilities. BMC Pregnancy Childbirth. 2022 Aug 9;22(1):631.

Palmer, D.J., et al. Maternal peanut and egg consumption during breastfeeding randomized pilot trial. Pediatr Allergy Immunol. 2022 Sep;33(9):e13845.

Parkin, K.,, et al. Risk Factors for Gut Dysbiosis in Early Life. Microorganisms. 2021 Sep 30;9(10):2066.

Peltier, M.R., et al. Maternal Hypothyroidism Increases the Risk of Attention-Deficit Hyperactivity Disorder in the Offspring. Am J Perinat. 2020 Oct 21.

Premji, S.S., et al. Prenatal allostatic load and preterm birth: A systematic review. Front Psychol. 2022 Oct 4:13:1004073.

Qiu, C., et al. Association Between Epidural Analgesia During Labor and Risk of Autism Spectrum Disorders in Offspring. JAMA Pediatr. 2020 Oct 12.

Rauh, V.A., et al. Impact of prenatal chlorpyrifos exposure on neurodevelopment in the first 3 years of life among inner-city children. Pediatrics. 2006;118;e1845-1859.

Rifas-Shiman, S.L., et al. Associations of prenatal or infant exposure to acetaminophen or ibuprofen with mid-childhood executive function and behaviour. Paediatr Perinat Epidemiol. 2020 May;34(3):287-298.

Rosman, N.P., et al. Association of Prenatal Ultrasonography and Autism Spectrum Disorder. JAMA Pediatr. 2018 Apr 1;172(4):336-344.

Rowley, C.E., et al. Altered dietary behaviour during pregnancy impacts systemic metabolic phenotypes. Front Nutr. 2023 Dec 4:10:1230480.

Silva, D.T., et al. Introducing the ORIGINS project: a community-based interventional birth cohort. Rev Environ Health. 2020 Sep 25;35(3):281-293.

Silvestrin, R.B., et al. Animal model of autism induced by prenatal exposure to valproate: altered glutamate metabolism in the hippocampus. BrainRes. 1495 (2013) 52–60.

Sucksdorff, M., et al. Maternal Vitamin D Levels and the Risk of Offspring Attention-Deficit/Hyperactivity Disorder. J Am Acad Child Adolesc Psychiatry. 2019 Dec 18.

Taddio, A., et al. Effect of neonatal circumcision on pain responses during vaccination in boys. Lancet. 1995 Feb 4;345(8945):291-2.

Taige, N.M., et al. Gestational Age at Term, Delivery Circumstance, and Their Association with Childhood Attention Deficit Hyperactivity Disorder Symptoms. Paediatr Perinat Epidemiol. 2016 Mar;30(2):171-80.

Tanneeru, S., et al. Evaluation of Microflora (Viral and Bacterial) in Subgingival and Placental Samples of Pregnant Women with Preeclampsia with and without Periodontal Disease: A Cross-Sectional Study. J Int Soc Prev Community Dent. 2020 Mar 10;10(2):171-176.

Tollånes, M.C., et al. Cesarean section and risk of severe childhood asthma: a population-based cohort study. J Pediatr. 2008 Jul;153(1):112-6.

Torres, G., et al. Perspectives of Pitocin administration on behavioral outcomes in the pediatric population: recent insights and future implications. Heliyon. 2020 May 29;6(5):e04047.

Vuillermot, S., et al. Vitamin D treatment during pregnancy prevents autism-related phenotypes in a mouse model of maternal immune activation. Mol Autism. 2017 Mar 7;8:9.

Wilcox, J.C., et al. Evaluating Engagement in a Digital and Dietetic Intervention Promoting Healthy Weight Gain in Pregnancy: Mixed Methods Study. J Med Internet Res. 2020 Jun 26;22(6):e17845.

Wang, A., et al. Association of Prenatal Exposure to Organophosphate, Pyrethroid, and Neonicotinoid Insecticides with Child Neurodevelopment at 2 Years of Age: A Prospective Cohort Study. Environ Health Perspect. 2023 Oct;131(10):107011.

Wang, S.S., et al. Polymorphisms in genes involved in folate metabolism as maternal risk factors for Down syndrome in China*. J Zhejiang Univ Sci B. 2008 Feb; 9(2): 93–99.

Watai,, K., et al. Epidemiological association between multiple chemical sensitivity and birth by caesarean section: a nationwide case-control study. Environ Health. 2018 Dec 14;17(1):89.

Willfors, C., et al. Medical history of discordant twins and environmental etiologies of autism. Transl Psychiatry. 2017 Jan; 7(1): e1014.

Williams, E.L., et al. Potential teratogenic effects of ultrasound on corticogenesis: implications for autism. Med Hypotheses. 2010 Jul;75(1):53-8.

Winter, C., et al. Dopamine and serotonin levels following prenatal viral infection in mouse—implications for psychiatric disorders such as schizophrenia and autism. European Neuropsychopharmacology. 2008 Oct;18(10):712-6.

Woodbury, M.L., et al. Examining the relationship of acetaminophen use during pregnancy with early language development in children. Pediatr Res. 2023 Dec 11.

Xiang, A.H., et al. Maternal Gestational Diabetes Mellitus, Type 1 Diabetes, and Type 2 Diabetes During Pregnancy and Risk of ADHD in Offspring. Diabetes Care. 2018 Dec;41(12):2502-2508.

Zaigham, M., et al. Prelabour caesarean section and neurodevelopmental outcome at 4 and 12 months of age: an observational study. BMC Pregnancy and Childbirth. 2020 (20)564.

Zengeler, K.E., et al. SSRI treatment modifies the effects of maternal inflammation on in utero physiology and offspring neurobiology. Brain Behav Immun. 2023 Feb:108:80-97.

Zhang, L., et al. Association of Maternal Short Sleep Duration With Neurodevelopmental Delay in Offspring: A Prospective Cohort Study. J Clin Endocrinol Metab. 2024 Sep 26:dgae569.