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Effects of Genetic Counseling on
Reducing Prenatal Stress and Autism
Rates in the Asia-Pacific Region
Yanhua Bi 1, Kadir Uludag 2
1 Zhejiang University, China
2 Shanghai Jiao Tong University Mental Health Center, China
Abstract: Autism Spectrum Disorder (ASD) is a neurodevelopmental condition characterized
by difficulties in social interaction, repetitive behaviors, and narrow interests. People with
ASD often experience additional mental health issues such as depression and anxiety. While
genetics have long been considered a significant factor in the development of ASD, recent
research indicates that the interplay between genes and the environment is crucial in
understanding its underlying causes. This chapter aims to discuss the relationship between
prenatal stress and the characteristics of ASD in countries within the Asia-Pacific region. The
findings indicate a connection between prenatal stress and the traits of ASD in China, South
Korea, and Japan. Further investigation is required to fully comprehend the specific
mechanisms involved in this relationship. Genetic consultation can provide insights into
potential risk factors, genetic counseling, and guidance on personalized interventions.
Keywords: Autism Spectrum Disorders, Prenatal Stress, Postnatal Stress, Asian Countries,
Genetic Consultation, Genetic Analysis, Genetic Counseling, Culture
ABOUT THE AUTHOR(S)
Yanhua Bi - MISSING BIOGRAPHY. PLEASE SEND TO THE EDITORS
Kadir Uludag - MISSING BIOGRAPHY. PLEASE SEND TO THE EDITORS
BOOK EDITORS:
Manuel B. Garcia
FEU Institute of Technology, Philippines
Rui Pedro Pereira de Almeida
University of Algarve, Portugal
Note: The book editors reserve the right to edit chapters for style, clarity, coherence, and brevity. Additionally, to
maintain a cohesive voice throughout the book, all book chapters will cite each other as much as feasible.
INTRODUCTION
Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder characterized
by impaired communication, social deficits, and repetitive behaviors. It affects 1 in 59
children (approximately 1.7%) in the USA, and 1 in 143 in China as of 2020 (Leigh & Du,
2015; Zhou et al., 2020). The incidence of ASD among children born in Japan who were
diagnosed with the disorder between 2009 and 2014 was 2.75%, whereas the total prevalence
of ASD among Koreans increased from 5.04 per 100,000 in 2008 to 10.97 per 100,000 in
2015 (Sasayama et al., 2021). Whereas the total prevalence of ASD among Koreans was 5.04
per 100, 000 in 2008 and increased to 10.97 per 100, 000 in 2015 (Hong et al., 2020). These
findings indicate a rising prevalence of ASD, particularly in the United States and Asia-
Pacific regions, encompassing countries such as China, Japan, and South Korea. The social
dynamics and cultural norms vary across the United States, China, Japan, and South Korea.
Cultural variables can vary even within a single country.
Nevertheless, expectant mothers frequently encounter social, economic, physical,
and psychological challenges and burdens during pregnancy, particularly in both
industrialized and developing nations (Furber et al., 2009). In contemporary society,
individuals are required to balance self-care, work responsibilities, and simultaneous
childcare duties (Kim & Chung, 2018). In China, Japan, and South Korea, there has been a
notable increase in the number of pregnant women who are engaging in employment to
provide support for their families. Moreover, it stands apart from previous generations due to
the substantial changes in work culture that have taken place. The stress experienced by these
women is influenced by several complex factors, including physical and psychological
changes, managing daily life, maternal and infant health, maternal role, family support,
healthcare services, social environment, and the challenge of balancing work and pregnancy
responsibilities for those who are working (Kim & Chung, 2018). Recent research conducted
in Japan revealed that pregnant women encounter limited social support and heightened pain
intensity throughout their pregnancy (Yamada et al., 2021). China is rapidly emerging as a
highly progressive nation in the Asia-Pacific region, experiencing significant growth and
development.
The prevalence of psychiatric problems such as depression, anxiety, and stress
during pregnancy was high in Chinese pregnant women (Gao et al., 2019; Hu et al., 2017; Ma
et al., 2019; Wu et al., 2020). In China, where the prevalence of depression, anxiety, and
stress during pregnancy is high, the main stress factors include lower educational
backgrounds, unplanned pregnancies, crowded residential conditions, lower household
income, and a greater number of previous deliveries, as well as poor sleep quality (Gao et al.,
2019; Hu et al., 2017). Pregnant women are at high risk of prenatal stress, depression, and
anxiety during early pregnancy (Tang et al., 2019), even during the COVID-19 period, as
evidenced by research papers published between 2019-2021 (Luo et al., 2021; Rodriguez et
al., 2021; Uludag, 2022; Wang et al., 2020; Zhang et al., 2021).
There is growing research examining the association between prenatal maternal
stress and the risk of neurodevelopmental disorders, including ASD and attention-
deficit/hyperactivity disorder (ADHD) (Class et al., 2014; Khashan et al., 2008; Manzari et
al., 2019; Rodriguez & Bohlin, 2005). However, ASD etiology has not yet been clearly
defined and identified. Novel technologies and large population-based studies provide new
insight into the environmental risk factors and genetic factors contributing to the etiology of
ASD (Modabbernia et al., 2017). Experiencing stress during pregnancy can have negative
consequences for expectant mothers, and both stress and maternal immune dysregulation
have been linked to an increased risk of ASD(Manzari et al., 2019). Autism with intellectual
disability is linked to increased levels of maternal cytokines and chemokines during
gestation(Vargas et al., 2005), as well as neuroglia and innate neuroimmune system activation
in the brain tissue and cerebrospinal fluid of autistic patients(Pardo et al., 2005). Recent
studies have demonstrated that infection, toxin exposures, maternal stress, and maternal
obesity influence inflammatory and immune pathways(P. Krakowiak et al., 2012; Volk et al.,
2014; Zerbo et al., 2015). Chemokines, cytokines interleukin-1, and epidermal growth factor
could penetrate the immature blood-brain barrier and perturbed neurodevelopment(Deverman
& Patterson, 2009), leading to severe and persistent behavioral and cognitive
abnormalities(Nawa & Takei, 2006).
MAIN FOCUS OF THE CHAPTER
While genetics have long been considered a significant factor in the development of
ASD, recent research indicates that the interplay between genes and the environment is
crucial in understanding its underlying causes. Studies have shown that prenatal exposure to
stress can impact both the neurodevelopment and immune system of offspring. Pregnant
women who are employed face particular vulnerability to prenatal stress due to various
pressures and demands. To prevent and address ASD, it is essential to comprehend the
mechanisms by which it develops and how environmental factors, including prenatal stress,
contribute to its occurrence. This chapter aims to discuss the relationship between prenatal
stress and the characteristics of ASD. Furthermore, we have incorporated inflammatory
biomarkers, such as microglia, into our review. Furthermore, as cortisol is a stress-related
marker, we have also incorporated cortisol into our study. Nevertheless, we have only
incorporated a limited number of biomarkers that are relevant to our subject matter.
This chapter pose significant contribution to the the areas of health literacy and
medical practice. The advent of advanced technologies is indeed fundamentally transforming
prenatal care, including genetic counseling. With the integration of sophisticated data
analytics, blockchain, artificial intelligence, and telemedicine (e.g., Barua et al., 2024; Miller
et al., 2024; Tariq, 2024), the process of interpreting and conveying genetic information to
expectant parents is becoming more precise and personalized. These technological
developments facilitate a deeper understanding of the interplay between genetic and
environmental factors, including prenatal stress, in the development of ASD. The rise of
educational technologies, including apps and online platforms, further augments the capacity
of pregnant women, especially those in high-stress jobs, to access information and strategies
for stress management. This chapter contributes to the evolving narrative of how emerging
technologies are essential in enhancing health literacy, reshaping medical practices (Datta &
Barua, 2024; Pramanik, 2024; Roy & Ashmika, 2024), and potentially reducing the incidence
of ASD through informed prenatal care.
BACKGROUND OF THE STUDY
The Influence of Asian Cultures on Autism Spectrum Disorder
The proportion of women in the workforce is increasing worldwide, including in
countries like Japan, South Korea, and China where cultural norms traditionally viewed
women as being primarily responsible for household labor and motherhood until the mid-20th
century. As these countries became industrial countries, more women entered the workforce
across all fields. Nevertheless, the rise in female employment has rendered women more
vulnerable to stress, both within their professional environments and within their domestic
lives, as illustrated in Figure 1.
Figure 1. The Causes of Persistent Stress During Pregnancy and Its Link to ASD
In the context of Japan, female employees tend to repress positive emotions when
confronted with work-related stressors and this behavior has been associated with psychiatric
conditions such as major depression (Kawakami & Haratani, 1999). Additionally, regardless
of employment status, domestic work stress has a significant impact on women's
psychological health. The well-being of women is connected to the impacts of household
chores, work-life balance challenges, the support received from family members, and various
factors within the occupational sphere (Kachi et al., 2020). A prior study suggested that
prenatal stress may lead to low birth weight, smaller head circumference, preterm delivery,
skewed sex ratios, and retardation of fetal brain development (Hibino et al., 2009).
In South Korea where 41% of the workforce is made up of women (Korean
National Statistical Office, 2003), work and family-related stress are critical factors that
impact women’s health and well-being in the workplace (Kim et al., 2005). Moreover,
women who have limited access to resources are at a higher risk of experiencing symptoms
of depression (Oh & Park, 2020).
In China, where around 70% of women participate in the labor force, women in the
workforce face not only the pressures of their jobs but also the demands of family
responsibilities such as child-rearing and eldercare. Some women even work throughout their
pregnancies, potentially harming fetal brain development. For those living in China's big
cities, the high cost of living can exacerbate these pressures, especially for young couples.
The effects of these conditions on the brain development of the fetus are still unclear.
Societies need to acknowledge and address the unique challenges that women face in the
workplace and at home, to promote their physical and mental health and well-being. By
providing support for working women, including resources for managing stress and balancing
work and family responsibilities, we can ensure that women's health is prioritized in the
workforce.
PRENATAL STRESS
Prenatal Persistent Stress
Mothers who experience anxiety, psychosocial stress, and depression are at risk for
various adverse health outcomes, such as cardiovascular disease, obesity, hypertension,
hyperlipidemia, insulin resistance, non-insulin-dependent diabetes mellitus, asthma, and other
health problems (Barker et al., 1993; Cookson et al., 2009; McCalman & Morley, 2003;
McCormack et al., 2003; Richards et al., 2001; Roseboom et al., 2000). Both mothers and
their fetuses are vulnerable to psychosocial and biological stress. Stress during pregnancy can
reduce offspring's affective responses to stress, impair memory function, and increase the risk
of postpartum depression (Sandman et al., 2012). Prenatal stress excess emotional and brain
structure modification in offspring (Soares-Cunha et al., 2018). Prenatal stress can also result
in emotional and structural changes in the brains of offspring, affect embryonic and adult
microglia, and disrupt GABAergic progenitor migration. Elevated glucocorticoids, which are
a risk factor associated with prenatal stress, can lead to increased anxiety, fearfulness,
cognitive impairments, and alterations in brain structure and function in offspring (Kim et al.,
2015; Krontira et al., 2020; Osborne et al., 2018). Elevated levels of glucocorticoids
additionally hinder the process of placental vascularization, leading to the disruption of the
protective barrier provided by the placenta (Krontira et al., 2020). Prenatal stress interferes
with the protective barrier of the placenta by increasing glucocorticoid levels, which is
achieved by inhibiting the vascularization of the placenta (Ozmen et al., 2017).
Recent studies have suggested that maternal stress exposure may play a vital role in
the development of ASD (Beversdorf et al., 2005; Beversdorf et al., 2018; Kinney et al.,
2008). The link between maternal stress and a range of adverse behavioral responses,
including fear and anxiety-like behaviors, as well as abnormal stress reactivity in offspring,
persists into adulthood (Ward et al., 2000; Weinstock, 1997). These findings emphasize the
importance of understanding the impact of prenatal stress on both maternal and child health
outcomes, including the potential contribution to the development of ASD and the long-term
consequences on behavior and stress regulation. Prenatal stress and its associated factors are
highly likely to have a significant impact on postnatal life as well. Additionally, these factors
have the potential to influence intricate epigenetic mechanisms.
Prenatal Stress and Genetics
Prenatal stress and genetics are two interconnected factors that have garnered
significant attention in the field of developmental psychology and reproductive health.
Prenatal stress refers to the psychological and physiological stress experienced by the mother
during pregnancy, which can have profound effects on the developing fetus. On the other
hand, genetics encompasses the inherited traits and genetic variations passed down from
parents to their offspring, playing a crucial role in shaping an individual's physical and
psychological characteristics. Eighteen human and sixteen animal studies on prenatal stress
interaction with genetic variants were reviewed. Maternal serotonin transporter genetics
interact with prenatal stress to affect offspring symptoms. Offspring serotonin, dopamine, and
stress physiology-related alleles interact with prenatal stress (Abbott et al., 2018).
The reviewed studies, encompassing both human and animal research, have shed
light on the interaction between prenatal stress and genetic variants. Specifically, maternal
serotonin transporter genetics have been found to interact with prenatal stress, impacting
offspring symptoms. Moreover, alleles related to serotonin, dopamine, and stress physiology
in offspring have demonstrated interactions with prenatal stress. These findings highlight the
intricate interplay between prenatal stress and genetics, emphasizing the need for further
research to better understand their combined effects on offspring outcomes and pave the way
for tailored interventions and support strategies in the realm of reproductive health.
Prenatal Stress and Evolutionary Psychology
There is evidence to suggest that when a mother experiences stress or anxiety during
pregnancy, her child may be more likely to exhibit symptoms of ADHD, conduct disorder,
aggression, or anxiety. For example, a previous study found that prenatal stress exposure was
associated with an increased risk of ADHD symptoms in children (Ronald et al., 2011). While
there is ongoing debate about the proportion of these effects that are due to prenatal versus
postnatal factors and the role of genetics, there is strong evidence to indicate that exposure to
prenatal stress can increase the risk of later psychopathology.
It is possible that in our evolutionary history, some increase in these characteristics
in certain individuals was adaptive in response to a stressful environment, and that fetal
programming prepared the child or group for the environment in which they were going to
find themselves (Glover, 2011). However, it is important to note that the stressors faced by
humans today are often very different from those in our evolutionary past. Furthermore, the
negative effects of prenatal stress exposure can have long-term consequences on an
individual's mental and physical health that may not be immediately apparent.
Therefore, it is crucial to recognize the potential risks of prenatal stress exposure and
take steps to reduce stress levels during pregnancy. This may involve seeking social support,
practicing relaxation techniques, and engaging in activities that promote overall well-being
(Aminabee, 2024; Lobo et al., 2024; Martin & Alarcón-Urbistondo, 2024). By doing so,
mothers can give their children the best chance for healthy development and positive
outcomes later in life.
POSTNATAL STRESS
Previous literature confirmed the relation between some prenatal, perinatal, and
postnatal factors with autism. There have been several studies exploring the relationship
between prenatal, perinatal, and postnatal factors and autism. A study published in the Journal
of the American Academy of Child and Adolescent Psychiatry in 2015 found that exposure to
maternal infection during pregnancy was associated with an increased risk of autism
(Atladóttir et al., 2012). Similarly, a study published in the journal Pediatrics in 2014 found
that infants who experienced birth complications such as low birth weight, birth asphyxia,
and neonatal hypoglycemia were more likely to be diagnosed with autism later in childhood
(Paula Krakowiak et al., 2012). Additionally, a recent study published in JAMA Pediatrics in
2020 found that exposure to air pollution during pregnancy was associated with an increased
risk of autism in offspring (Raz et al., 2015). All these factors were examined individually,
thus it was still unclear whether these factors are causal or play a secondary role in the
development of autism (Wang et al., 2017). While these studies provide valuable insights into
the potential links between various prenatal, perinatal, and postnatal factors and autism, it is
important to note that they do not establish causation. Further research is needed to better
understand the complex interplay between genetic, psychological, and environmental factors
in the development of autism.
INFLAMMATORY BIOMARKERS, AUTISM, AND GENETICS
In recent years, there has been growing interest and research focused on the role of
inflammatory biomarkers, autism, and genetics in understanding the complex etiology of
ASD. Inflammatory markers, including microglia, play a crucial role as valuable biomarkers
in providing insights into an individual's health status. Furthermore, inflammatory markers
are used for prediction in the field of psychiatry (Uludag et al., 2023).
Microglia
Microglia plays a critical role and is one of the most important glial cells in the
central nervous system, which colonizes the fetus as primitive myeloid precursor cells from
the yolk sac, starting from the 9th day of the embryo (Ginhoux et al., 2010). Immune
molecules and glia are vital for normal development and the CNS environment (Deverman &
Patterson, 2009). Recent studies have suggested that microglial activation may be involved in
the pathogenesis of ASD (Morgan et al., 2010; Vargas et al., 2005). When microglia are
activated by any perturbation, they can be long-lived and remain activated chronically (Town
et al., 2005). Activation of microglia leads to the production of sensitized inflammatory
responses that can have a detrimental impact on the CNS, leading to abnormal neuronal
connectivity and function. Our review hypothesized that microglial activation by non-
infectious environmental factors in pregnancy-prenatal persistent stress is a critical
mechanism in the pathophysiology subtype of ASD for a wide segment of the population.
Non-infectious environmental factors such as prenatal persistent stress may trigger microglial
activation, leading to an increased risk of ASD. Evidence suggests that mothers who
experience stress during pregnancy have a higher likelihood of having children with ASD,
and exposure to prenatal stress in animal models leads to microglial activation and ASD-like
behaviors in offspring. It is important to note that microglial activation is not the only
mechanism involved in the pathophysiology of ASD. Genetic and epigenetic factors also play
a role in the development of ASD. Further research is needed to better understand the
complex interplay between microglial activation and other risk factors for ASD to develop
effective prevention and treatment strategies.
Microglia and Prenatal Persistent Stress
Microglia, which are immune cells in the brain, change both the fetal and postnatal
rodent brain due to prenatal stress and maternal immune activation. These alterations include
significant changes in the density of multivacuolated microglia, as well as variations in the
number of microglia and their activation levels (Bilbo et al., 2018; Bittle & Stevens, 2018;
Gumusoglu et al., 2017). However, the specific microglial changes in maternal physiology
under stress are not well understood. Disruptions to normal microglial development,
including those caused by infection, toxins, and stress, may contribute to aberrant microglial
development, potentially having long-lasting effects on brain function and increasing the risk
of various diseases (Hanamsagar & Bilbo, 2017). We hypothesize that when pregnant women
reside in a relaxed environment, their offspring's cognitive pathways, including thinking and
decision-making, function efficiently, akin to driving on a smooth, high-speed road.
Conversely, when pregnant women are in a highly stressed environment, it may adversely
affect the offspring's microglia morphology and activation, leading to cognitive pathways that
are less efficient, similar to driving on an uneven road (Figure 2).
Figure 2. How Prenatal Stress and a Relaxing Environment Influence Cognitive Pathways in Decision-
Making and Thinking
Cortisol, Stress, and Autism
Cortisol, stress, and autism have emerged as interconnected factors that have drawn
considerable attention in the field of autism research. Recent evidence has shed further light
on the complex relationship between cortisol, stress, and autism. A study published in 2021
found that children with autism and high levels of anxiety exhibited altered cortisol rhythms
compared to typically developing children and those with autism without anxiety (Corbett et
al., 2006). This suggests that anxiety may play a role in the dysregulation of the cortisol
system in individuals with autism. Overall, the literature highlights the potential impact of
caregiving stress on cortisol dysregulation in individuals with autism. The level of cortisol in
the amniotic fluid, surrounding the baby in the womb, is inversely correlated with infant
cognitive development (Glover, 2015). Overall, these recent studies suggest that cortisol
dysregulation in individuals with autism is likely to be influenced by a range of factors,
including anxiety, caregiving stress, and potentially altered neurodevelopmental processes.
Further research is needed to better understand these complex interactions and to develop
effective interventions to support stress management in individuals with autism and their
caregivers.
THE SIGNIFICANCE OF GENETIC COUNSELING
Significant progress has been made in various areas, such as the understanding of
inherited diseases, advancements in the examination of human chromosomes to identify
chromosomal abnormalities, and the ability to diagnose specific diseases during the second
trimester of pregnancy (Fraser, 1974). Genetic counseling involves assisting individuals in
comprehending and adjusting to the medical, psychological, and familial consequences
related to the genetic factors contributing to diseases (Resta et al., 2006).
A "genetic counselor" refers to a health professional at the master's level who has
received comprehensive training in human genetics as well as counseling abilities(Bennett et
al., 2003). There is a consensus among genetic counselors that conducting genetic counseling
in a morally impartial manner is essential (Caplan, 2020; Garcia et al., 2024). Genetic
counselors are depicted as fulfilling various roles, including that of a genetics educator,
mediator, lifestyle advisor, interpreter of risks, and entrepreneur (Harris et al., 2013).
Additionally as mentioned in the previous study (Ritvo et al., 1989), the estimated overall
risk of autism recurrence (the likelihood of each subsequent sibling of an autistic child
developing autism) is 8.6%. If the first autistic child is male, the estimated recurrence risk is
7%, while for a female, it is 14.5%. It is important to provide these updated recurrence risk
estimates to individuals with autistic children who are considering family planning (Ritvo et
al., 1989). Furthermore, studies published from 1961 to 2003, support the notion that autism
is primarily caused by a combination of multiple genetic factors (Muhle et al., 2004).
Furthermore, the remarkable progress made in understanding the genetic aspects of autism
through genetic and molecular research, coupled with the development of new diagnostic
tools, has significantly transformed the landscape, allowing for the identification of a
potential underlying genetic cause in approximately 25% of autism cases using the currently
available molecular tests (Griesi-Oliveira & Sertié, 2017).
In conclusion, significant advancements in the understanding of inherited diseases,
chromosomal examination, and prenatal diagnosis have paved the way for genetic counseling
to assist individuals in comprehending and adapting to the medical, psychological, and
familial implications of genetic factors contributing to diseases. Genetic counselors, who
possess specialized training in human genetics and counseling, play diverse roles in
educating, mediating, advising on lifestyle, interpreting risks, and even entrepreneurship. It is
crucial to provide the latest recurrence risk estimates for autism to individuals with autistic
children considering family planning.
SUGGESTIONS FOR FURTHER STUDIES
Access to genetic counseling should be provided for individuals who are part of at-
risk groups. Furthermore, efforts should be made to educate individuals about the importance
and availability of genetic counseling, encouraging them to seek it when appropriate.
Collaborations between healthcare professionals, genetic counselors, and community
organizations can help raise awareness and reach underserved populations (Almeida, 2024;
Hauwaert et al., 2024; Silva et al., 2024). Integration of genetic counseling into routine
healthcare practices, such as preconception care and prenatal screening, can also enhance
accessibility. Moreover, ongoing research and advancements in genetic testing technologies
should be supported to expand the scope and accuracy of genetic counseling services.
Additionally, it is important to propose a solid framework that can be used for the evaluation
of genetic services as mentioned in the previous study (Wang et al., 2004).
While patient satisfaction has gained considerable attention in evaluating medical
care, it has been relatively overlooked in the context of genetic counseling (Shiloh et al.,
1990). Given the relative neglect of patient satisfaction in the realm of genetic counseling, it
is crucial to address this issue and make improvements to enhance the overall patient
experience. Here are some suggestions to consider:
1. Implement patient feedback mechanisms: Establish systems that allow patients to
provide feedback on their genetic counseling experience. This can be in the form of
surveys, questionnaires, or follow-up interviews. Gathering patient perspectives will
help identify areas for improvement and ensure their satisfaction is taken into account.
2. Enhance communication and information sharing: Clear and effective
communication is vital in genetic counseling. Counselors should strive to explain
complex genetic concepts in a way that patients can understand. Providing
comprehensive and accurate information about genetic testing options, potential
outcomes, and available support services can empower patients and contribute to their
satisfaction.
3. Foster a supportive and empathetic environment: Genetic counseling can be an
emotionally charged experience for patients and their families. Creating a
compassionate and supportive atmosphere can significantly impact patient
satisfaction. Counselors should demonstrate empathy, active listening, and respect for
patients' concerns and emotions throughout the counseling process.
4. Continuous professional development: Genetic counselors should engage in
ongoing professional development and training to stay updated on the latest research,
counseling techniques, and patient-centered approaches. This will enable them to
provide high-quality services that meet patients' needs and expectations, ultimately
enhancing patient satisfaction (Silva et al., 2024).
5. Collaborative decision-making: Involving patients in the decision-making process
(Thapliyal et al., 2024) regarding their genetic testing and healthcare options can
increase their sense of control and satisfaction. Genetic counselors should strive to
facilitate shared decision-making, providing patients with the necessary information
and guidance to make informed choices about their genetic healthcare.
6. Evaluate and address wait times: Minimizing wait times and optimizing
appointment scheduling can contribute to patient satisfaction. Efficient management
of clinic schedules and timely communication of appointment reminders can help
reduce patient anxiety and frustration.
By implementing these suggestions and prioritizing patient satisfaction in genetic
counseling, healthcare providers can ensure that patients receive comprehensive, empathetic,
and patient-centered care, finally leading to improved outcomes and overall satisfaction. In
addition, it is imperative to prohibit work conditions that prioritize profits over the well-being
of individuals and are unsuitable for human welfare. To address this issue effectively, the
following suggestions can be considered:
1. Implement and enforce labor regulations: Governments should establish and
enforce strict labor regulations that prioritize the health, safety, and overall well-being
of workers. These regulations should include provisions for reasonable working
hours, fair wages, safe working conditions, and adequate rest breaks.
2. Promote work-life balance: Encourage employers to adopt policies that promote
work-life balance, such as flexible working hours, telecommuting options, and paid
time off. This allows employees to maintain a healthy equilibrium between their
professional and personal lives, reducing stress and promoting overall well-being.
3. Foster a positive and inclusive work culture: Create a work environment that values
employee well-being and fosters a sense of belonging and support. Encourage open
communication, provide opportunities for professional development, and address any
instances of discrimination or harassment promptly and effectively.
4. Prioritize employee mental health: Recognize the importance of mental health in
the workplace and provide resources and support for employees to address their
mental well-being. This can include access to counseling services, mental health
awareness programs, and initiatives that reduce the stigma surrounding mental health
issues.
5. Encourage employee participation and feedback: Empower employees by
involving them in decision-making processes and seeking their feedback on work
conditions. This can be achieved through regular surveys, suggestion boxes, or
employee representative bodies. Actively addressing and implementing employee
suggestions can improve overall satisfaction and well-being.
It is crucial to take these criteria into account from the perspective of individuals
who have children with autism. Moreover, further reviews can explore additional
inflammatory biomarkers (C-reactive protein, tumor necrosis factor-alpha, interleukin 6,
interleukin 1 beta) that can be utilized in the context of autism, prenatal stress, and genetics.
Exploring the potential involvement of other inflammatory markers, such as interleukin 8
(IL-8), interferon-gamma (IFN-γ), and transforming growth factor-beta (TGF-β), may
provide a more comprehensive understanding of the intricate relationships between these
factors. By examining a broader range of inflammatory biomarkers, researchers can gain
deeper insights into the underlying mechanisms and potential biomolecular pathways
involved in the complex interactions between autism, prenatal stress, and genetic factors.
Moreover, it is worth considering the inclusion of oxidative stress markers as potential
biomarkers in addition to the previously mentioned inflammatory markers. By incorporating
these markers into research and clinical studies, a more comprehensive understanding of the
oxidative stress response and its implications can be attained, particularly about autism,
prenatal stress, and genetics.
Moreover, it is crucial to conduct regular prevalence studies to monitor the rates of
genetic diseases consistently. By implementing these suggestions and prioritizing prevalence
studies, we can effectively track rates of genetic diseases, improve early detection, enhance
patient care, and work towards better management and prevention strategies. In the context of
ASD, several factors are noteworthy:
1. Early Detection and Intervention: AI-based methods possess the potential to
identify early indicators of diseases and disorders, thereby enabling timely
intervention and support for affected individuals (Garcia et al., 2021; Maaliw et al.,
2022; Suriyan & Nagarajan, 2024). This approach could apply to ASD.
2. Enhanced Diagnostic Precision: Artificial intelligence algorithms can analyze
extensive datasets, facilitating the identification of complex relationships between
clinical and behavioral factors associated with ASD. This can lead to more precise and
accurate diagnostic processes (Barua, 2024).
3. Automation and Efficiency: AI technologies offer automation of various diagnostic
aspects, streamlining the assessment process and improving efficiency in identifying
ASD-related indicators.
It is important to consider these factors as they demonstrate the potential benefits of
utilizing AI in the diagnosis and management of autism disorder.
CONCLUSION
The culture and industrialization processes of the three countries in the Asia-Pacific
region are very similar. In the process of urbanization, many women migrate into cities in
search of jobs and living, but at the same time, they are also facing the pressure of life and
work. Many women marry men in major cities and become pregnant. These pregnant women
often keep working. It is unclear whether these external pressures will affect the outbreak of
psychiatric diseases, and the social interaction and neurodevelopment of young children.
However, the incidence of autistic children in these three countries is very high. The high
outbreak of ASD is a certain similarity with the labor participation rate of women in three
countries. Therefore, we predict that the high incidence of autism in China, South Korea, and
Japan is related to women’s persistent stress during pregnancy. It is crucial to acknowledge
that the incidence of autism in China, South Korea, and Japan is a complex issue that requires
a more comprehensive approach to understanding the underlying causes. Genetics also plays
a significant role in the development of autism, and environmental factors such as stress
during pregnancy may increase the risk, but they are not the sole cause. Furthermore, it is
essential to avoid stigmatizing or blaming mothers for the development of autism in their
children. The causes of autism are multifactorial and complex, and it is crucial to approach
this issue with sensitivity and empathy. To address the challenges associated with autism in
these countries and globally, research efforts should focus on identifying the various factors
that contribute to the development of autism and developing effective interventions and
support systems for individuals with autism and their families. Taking a comprehensive and
nuanced approach is essential to understanding and addressing the challenges associated with
autism. Genetic counseling has the potential to contribute to the reduction of autism rates in
Asian countries (e.g., China, Japan, and South Korea) and across the globe.
ADDITIONAL READING
Akrivopoulou, C. M. (Ed.). (2015). Protecting the Genetic Self from Biometric Threats:
Autonomy, Identity, and Genetic Privacy. IGI Global. https://doi.org/10.4018/978-1-4666-
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KEY TERMS AND DEFINITIONS
Autism Spectrum Disorder (ASD): A neurodevelopmental disorder characterized by
challenges with social interaction, communication, and often accompanied by repetitive
behaviors. ASD encompasses a range of conditions that were previously considered separate
– autism, Asperger's syndrome, childhood disintegrative disorder, and an unspecified form of
pervasive developmental disorder.
Cortisol: A steroid hormone produced by the adrenal glands, often referred to as the "stress
hormone" as its levels increase in response to stress. It plays a crucial role in regulating
various bodily functions including metabolism, immune response, and stress responses.
Genetic Counseling: A process that involves analyzing and advising individuals about the
genetic risks and implications of inherited disorders. It helps individuals understand and
adapt to the medical, psychological, and familial implications of genetic contributions to
diseases.
Microglia: Specialized immune cells located in the brain and spinal cord, part of the central
nervous system's immune defense. They play a key role in brain maintenance, including the
removal of damaged neurons and infection control, and have been implicated in the
pathology of various neurodevelopmental disorders.
Prenatal Stress: The stress experienced by a pregnant woman, which can have significant
impacts on the fetus's development. This stress can be psychological or physiological and is
known to affect both the mother and the developing fetus, potentially leading to long-term
health and developmental consequences.
Psychopathology: The study of abnormal behaviors and mental disorders. In the context of
this paper, it refers to the potential developmental and psychological disorders that can arise
as a result of prenatal stress or other factors related to ASD.
Neurodevelopmental Disorders: A group of disorders that affect the development of the
nervous system, leading to abnormal brain function which may affect emotion, learning
ability, self-control, and memory. ASD falls under this category.
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