Mothers' fears and concerns about subsequent pregnancy after raising a child with autism: a qualitative study

In Iran, as globally, autism spectrum disorder (ASD) imposes a significant burden on families, with extensive local research documenting high levels of stress, stigma, and reduced quality of life among mothers as primary caregivers. Building on this established context of caregiver impact, this study explores how these experiences shape a specific consequential decision: the consideration of another pregnancy. This qualitative study aims to explore the dimensions and context of the specific fears and concerns of mothers of children with autism regarding a subsequent pregnancy, to guide the development of targeted psychosocial support.

A qualitative content analysis was conducted using in-depth, semi-structured interviews with 27 purposively selected participants. Data were collected between September 2024 and October 2025 from selected autism-focused schools and rehabilitation centers in Birjand and Mashhad, Iran, and analyzed inductively following Graneheim and Lundman's [35] approach. Transcripts were coded and managed systematically with the aid of MAXQDA 2020.

A qualitative content analysis delineated 10 distinct subcategories of fears within two overarching categories. The first, individual dreads and apprehensions (8 subcategories), included fears of autism recurrence, physical harm to a newborn or the mother, neglecting either child, pregnancy difficulties, having an autistic daughter, concerns about the impact on a future healthy child's marriage prospects, the fear of exacerbated pressures and long-term worries about sibling relationships. The second, social dreads (2 subcategories), centered on the fear of social blame and judgment from others for considering another pregnancy. Collectively, these fears often dampened the desire for further childbearing and resulted in the decision to forgo having more children.

This study reveals that the journey toward considering another pregnancy for mothers of autistic children is profoundly overshadowed by a spectrum of concrete fears and worries. These fears collectively culminate in the decision to forgo further childbearing. These findings underscore the urgent need for holistic, compassionate support that moves beyond biomedical risk to address psychological, practical, and social dimensions, thereby empowering mothers in their reproductive autonomy.