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

BACKGROUND: 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.

METHODS: A qualitative content analysis was conducted using in-depth, semi-structured interviews with 27 participants selected through purposive maximum variation sampling. 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 (2004) approach. Transcripts were coded and managed systematically with the aid of MAXQDA 2020.

RESULTS: A qualitative content analysis delineated 10 distinct subcategories of fears within two overarching categories. The first, individual dreads and apprehensions (8 subcategories), included fears and concerns of autism recurrence, physical harm to a newborn or the mother, neglecting either child, pregnancy difficulty while mothering an autistic child, having an autistic daughter, worry about the next healthy child's marriage and family formation, the fear of intensified pressures and long-term worries about sibling relationships (concern and fear of lack of acceptance of one child by the other). 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.

CONCLUSION: This study showed that mothers of autistic children have various fears and concerns when thinking about another pregnancy. These fears often prevent further childbearing and may even cause mothers to decide not to have more children. The study's findings highlight the need for holistic and compassionate support programs that also address psychological, practical, and social issues.