Multivitamins and folic acid may reduce risk of autism in children

For the current study, researchers examined prescription data for the mothers of 45,300 Israeli children born between 2003 and 2007.

By JUDY SIEGEL-ITZKOVICH
Group of students raising hands during a lesson in the classroom. [Illustrative] (photo credit: INGIMAGE)
Group of students raising hands during a lesson in the classroom. [Illustrative]
(photo credit: INGIMAGE)
Women who take folic acid (the B complex vitamin) and multivitamins before and during pregnancy may be less likely to have children with autism than mothers who don’t take such supplements, according to a study led by Prof. Stephen Levine of the University of Haifa’s community mental health department.
Vitamin deficiencies in mothers have long been linked to problems with neural defects in the brain, spinal cord and spine. While pregnant women are advised to take folic acid and multivitamins in part to prevent neural tube defects, research to date has offered a mixed picture of whether this might also minimize the risk of autism.
For the current study, researchers examined prescription data for the mothers of 45,300 Israeli children born between 2003 and 2007. By 2015, 572 of these children, or 1.3%, had received a diagnosis of autism spectrum disorder (ASD).
Women who took folic acid, multivitamins, or both supplements before pregnancy were 61% less likely to have an autistic child, the study found. When women took supplements during pregnancy, they were 73% less likely to have a child with autism, they wrote in the journal  JAMA [Journal of the American Medical Association] Psychiatry.
“The results reinforce existing evidence that maternal use of prenatal vitamins and folic acid are associated with a reduced risk of autism in offspring,” said Levine told Reuters Health via email. “In addition, our results suggest that factors before pregnancy may be a target for further scrutiny to reduce the likelihood of autism.”
Autism is relatively common, affecting one in 160 children around the world, according to the World Health Organization. The exact cause is unclear, but scientists suspect that a variety of environmental and genetic factors may play a role.
Symptoms around the age of two and can include a range of challenges with social interactions, behavior, communication and language as well as an intense, repetitive focus on certain interests or activities.
The current study included 11,917 children whose mothers took folic acid or prenatal vitamins alone or in combination before they became pregnant, as well as 21,884 children born to mothers who did so during pregnancy.
Mothers who only used folic acid had a 44% lower risk of having a child with autism when they used it before pregnancy and 68% lower risk when they took it during pregnancy.
Women who used only prenatal vitamins had 64% lower odds of having an autistic child when they took them before pregnancy and a 65% lower risk when they took the vitamins during pregnancy.
The study wasn’t a controlled experiment designed to prove whether or how taking folic acid or prenatal vitamins might directly prevent autism. Prescription data may also not be an accurate reflection of which women took the supplements.
“It is still unclear if folic acid or other micronutrients are what confers this reduced risk of ASD,” commented Dr. Joseph Braun, a researcher at Brown University School of Public Health in Rhode Island, who wasn’t involved in the study.
“In addition, other behavioral or lifestyle factors (such as more physical activity and lower rates of obesity) may be the real factors that reduce the risk of ASD; these are more likely to be present in women with multivitamin and folic acid supplement use,” Braun said.
While starting supplements before pregnancy is ideal, results from this study and others suggests that women can still benefit if they don’t start until after they become pregnant, said Dr. Pal Suren of the Norwegian Institute of Public Health in Oslo, who also wasn’t involved in the study.
“These studies provide yet another reason for taking folic acid, in addition to the preventive effect against neural tube defects that has already been demonstrated.”
REACHING THE BREAKING POINT
To better understand why many elderly people are prone to break a bone in a fall (known as bone fragility fractures), doctors and researchers might be well advised to look at the human skeleton in much the same way civil engineers analyze buildings and bridges, according to a new study from a mechanical engineering professor at the University of Utah.
The study was recently published in the journal Nature Biomedical Engineering.
A team of researchers led by Prof. Claire Acevedo believes the bones of an older person become more susceptible to a break due to repeated stress from everyday activities such as walking, creating micro-damage that affects the quality of the bone. That is in contrast to the commonly held belief that bone breaks in the elderly are largely due to one massive impact or force on the bone, such as a fall.
“It really starts with a small micro-crack that grows over time under repeated loading,” said Acevedo. “You need to be doing something like just walking or moving, while the crack is slowly propagating. At some point, the remaining cross-section of the bone that is still connected is too small and will break suddenly.” In that case, such fractures in the elderly would be the cause of a fall rather than the result of a fall.
Acevedo says this theory that “cyclic loading” (repeated and fluctuating loads) might be a bigger contributor to bone breaks is similar to the study of structures and engineered materials. This type of stress in structures and materials resulted in a rise of catastrophic accidents near the turn of the 20th century and has led to the development of “fracture mechanics.”
“In engineered materials and structures, cyclic fatigue is the most ubiquitous mode of failure,” wrote Acevedo, who studies fractures and stress on skeletal tissue. “Cyclic fatigue accounts for more than 80% of all failures, leading to catastrophic and sudden accidents such as the failure of railway axles, the collapse of metallic bridges, the failure of ships and the cracking of aircraft airframes and engines.
The research is based on examining not just the bone’s mineral density (bone mass) but its quality, specifically how well the collagen that provides the ductility of the bone deforms to resist fractures. And as one gets older, the more micro-damage that person accumulates over time and the weaker the bones get.
“Bone quality is much more important than what we have been thinking,” she said. “Old bones gradually lose their mechanical properties, their ability to self-repair and to recover bone quality to prevent the formation of a fracture.”
“Fatigue is really important, and bone quality is really important. We need to change our mind about that,” she says. “We need to change our approach on how to study it and not just look at the effect of a single load if we want to prevent such fractures and the high risk of mortality associated with them.”


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