New Findings in Reducing Autism Risk
Over the years, there has been a lot of speculation surrounding autism. I have heard all the theories and associations - the most prevalent of which involve immunizations. I must admit that the trends parallel the increasing prevalence of immunized and autistic children. However, rigid statistical analysis has dispelled any association... really. I've even seen comparison data pairing rising rates of autism to increasing organic food sales over the past couple decades.
My point is that links and causal factors in the autism arena are elusive. This is frustrating for all involved, as we watch numbers increase with little ability to help in regards to prevention and treatment. Recently, however, an association between folate supplementation and autism was discovered that offers hope in countering the increasing trends.
Folic Acid (folate)
Folic acid is actually a vitamin, B9, that is important in numerous bodily functions. Since it cannot be synthesized within the body, it's important that we incorporate this into our diet. The main natural source of folic acid is green, leafy vegetables. However, in western society, breads and cereals are often fortified with folic acid.
Deficiencies in folic acid can cause numbness in the limbs, confusion, depression, anemia, and mouth ulcers, among other issues, but perhaps the most harmful, permanent damage from folic acid deficiency is passed from mother to baby early in pregnancy.
Folic acid is essential for early development of the early nervous system called the neural tube. Low levels of folic acid have been linked to neural tube defects and neurodevelopmental disorders, most commonly spina bifida (a condition where the spine does not completely close). These types of problems can be fatal or lead to serious lifetime disability. Folic acid supplementation, when taken appropriately, reduces risk for these disorders. Prenatal vitamins contain around 1 mg of folic acid, which is plenty as a daily dose.
Though folic acid supplementation has been shown to decrease the risk of associated disorders of the nervous system, treating women is problematic. The issue here is that the neural tube develops and closes very early in pregnancy, before many women even know that they are pregnant. In fact, beginning folic acid supplements when a woman finds out she's pregnant is considered too late. To appropriately supplement, a woman needs to be on folic acid before conception. In reality, however, many to most pregnancies are not planned or well thought out.
A paper from the Norwegian Mother and Child Cohort Study recently reported that folic acid supplementation by mothers around the time of conception was associated with a lower risk of autism. This cohort is a national registry in Norway of 109,000 children born in the decade between 1999 and 2009 in which countless health habits among the mothers and children were evaluated. Notably, a comparison of mothers who took folic acid and those who did not revealed a disparity in regards to those children who were later diagnosed with autism.
Considering the large number of children involved and the fact that most autism is diagnosed during the toddler years, this study offered excellent potential to find an association, if indeed one exists. In the study, 270 children (0.32%) were diagnosed with autism. Of the mothers who took folic acid during the appropriate times, autism was diagnosed in 0.10%. In those who did not supplement with folic acid, autism was diagnosed in 0.21%. This data showed the risk reduced by more than half for the development of autism when folate was taken.
These findings do raise some questions. Given the pitfalls with timing of folic acid supplementation and associated issues, it's fair to wonder if parental vigilance and responsibility are confounding factors. Women who took folic acid regularly were indeed more likely to be highly educated, fit, non-smokers with planned pregnancies. To account for this, however, the investigators also assessed the use of fish oil supplements in the population, which fits the same demographic as folic acid but didn't affect the risk of autism.
We have a long way to go toward understanding and preventing autism, but any new data suggesting an association is encouraging. Given the established importance of folic acid in the early development of the brain and neural tissue, the connection makes sense. Statistically, the study data seems to show an association, but it's clearly not the whole picture.
As folic acid is a necessary vitamin with established benefits in the prevention of neural tube defects, women should be taking it anyway around the onset of pregnancy. As such, I highly recommend it for its potential to benefit with nil risk of harm. Like with many issues, though, education and vigilance pose significant stumbling blocks to universal implementation.