Maternal Metabolic Conditions and Risk for Autism and Other Neurodevelopmental Disorders

9 Apr

A study from the U.C. Davis MIND Institute was published today in the journal Pediatrics: Maternal Metabolic Conditions and Risk for Autism and Other Neurodevelopmental Disorders. The link is to the abstract, but the full paper is available free for download.

The paper is part of the CHARGE Study. (CHARGE: Childhood Autism Risks from Genetics and the Environment). The study looked for increased risk of a child being diagnosed autism if the mother had metabolic conditions during pregnancy. The metabolic conditions studied were diabetes, hypertension and obesity. They found a possibly heightened risk of autism for these pregnancies. I wrote a more in-depth summary which is available at the Autism Science Foundation blog .

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24 Responses to “Maternal Metabolic Conditions and Risk for Autism and Other Neurodevelopmental Disorders”

  1. passionlessDrone April 10, 2012 at 03:43 #

    Hello friends –

    Can I take this opportunity that I posited this possibility over two years ago on my blog, Intriguing Findings – Maternal Obesity, Inflammation, and Consequent Priming of Microglia, Immune Alterations, and Spatial Processing in Offspring (!)

    A paper that shows immune, behavioral, and even spatial processing changes in the offspring that have similarities to the findings in the autism population?

    It is informative to also consider another paper from IMFAR last year, Increased midgestational IFN-g, IL-4 and IL-5
    in women bearing a child with autism:
    , which showed pretty much as the title suggests. It just so happens, another study, Increased levels of both Th1 and Th2 cytokines in subjects with metabolic syndrome (CURES-103) found several of the same cytokines (and others), increased in a study on metabolic syndrome in pregnancy.

    I’d say that this has some rather profound implications for the question of incidence.

    – pD

    • Sullivan April 10, 2012 at 20:58 #

      pD–

      good stuff. One caution to consider when one tries even a back-of-the-envelope calcuation of the effect of obesity trends on autism incidence.

      Consider Figure 4 of this report: http://www.cdc.gov/nchs/data/databriefs/db82.pdf

      Obesity prevalence is going up, but mostly in males. Obesity prevalence in the past 10 years for female adults is relatively flat. Also, age distributions of obesity are different for men as opposed to women. Obesity is higher amongst older vs. younger women, but is more flat with age for men.

  2. McD April 10, 2012 at 04:14 #

    I can see this one going down like a cup of cold sick with the warrior-mom crowd.

    Nice to see the paper is open access too, and thanks for the link to your nice summary, Sullivan.

    IIRC the relationship between fetal and maternal health is complex and interactive. The fetus to some extent is exerting control over the mother’s health – hence conditions such as gestational diabetes. My obstetrician described this to me as the fetus attempting to maximise its own allocation of resources at the expense of the mother’s health. There is a battle going on in the womb, paternal genes and epigenetic factors are pitted against maternal ones. And then a mother’s genetic interests may not reflect her personal interests as an individual. I found it fascinating (got an aspie obsession and spent several months diving into philosophy of biology issues while I was pregnant; I got both gestational diabetes and pregnancy asthma, neither of which have made any show since).

    So absolutely not surprised that maternal health is gaining more empirical support as another risk factor for autism, among the fascinating ones of the last few weeks.

  3. McD April 10, 2012 at 04:28 #

    So pD, what do you think? this would be yet another wee contributor to the observed increase. As you note on your blog, people are getting larger.

    The problem with this is that there is just an association, not directionality shown here. The autistic fetus could be triggering gestational diabetes and MR in the mother perhaps.

    I do think that the rise in heroic treatment of at risk pregnancies is contributing to the increase in autism prevalence. This study may reflect part of that. Pregnancies that would have failed in the past, are now progressing. In my own case, without the specialist intervention I received my son would not have been born (he also would not have survived his first year without anti-biotics, another story)

  4. Dee April 10, 2012 at 06:51 #

    As a warrior mom, this confirms an emerging idea that autism incidence is increasing along with prevalence… It also supports the idea that genetics plus environment can trigger autism. As the warrior mom of an absolutely amazing three year old currently with a DX of autism who also happened to be severly obese at the time, I understand that a “perfect” storm of several factors including obesity, infections during pregnancy, an MTHFR mutation, Faragile X premutation and a fever at 19 months sent my son into mitochondria dysfunction, altering his GABA/glutathione levels for which I unknowingly treated with Tylenol (effecting these levels further) which led to a severe and scientist confirmed regression into autism. The great thing is that it’s treatable. Medically. What I’d like to highlight is that recent science understanding these issues allows us to treat this as a disease and “fix” the biological problem before it’s too late. Warrior moms, curbsies, and the like aren’t all what the stereotypes insist… New science means new treatment for the underlying medical conditions that effect the neurology… The money going into this research, cause and treatment has had a profound effect on my family. I am commenting in hopes that others will seek genetic testing, that money will continue to go into research, medical treatment will become legitimized, and that there could be an understanding between parents who seek to “fix” their child’s biological problems and those who make the world a better place with their advocacy.

  5. lilady April 10, 2012 at 07:51 #

    Thanks so much for the link to the full text article in the “Pediatrics” Journal.

    There is a blog about this study on the Huffington Post website and, as usual, the same crank comments from the anti-vaccine crowd appear…*it’s the vaccines*, *too many, too soon* and other assorted nonsense.

    Here is a good link about diabetes during pregnancy:

    http://www.cdc.gov/reproductivehealth/maternalinfanthealth/PregComplications.htm

    There is a very strong link with having gestational diabetes during pregnancy and being diagnosed with Type II diabetes within a few short years of that pregnancy.

    LGA (Large for Gestational Age) babies require special care in the newborn nursery and monitoring of their serum glucose levels…they truly are the fragile giants in special care nurseries.

    http://www.chp.edu/CHP/P02383

    We do have an epidemic of childhood and adult obesity in the United States. I fear that as young obese females grow up and are starting their own families, we will have many more woman and neonates put at risk, due to metabolic syndrome, insulin-resistance and diabetes, during pregnancy.

  6. Denice Walter April 10, 2012 at 17:35 #

    @ McD:

    Yes, there’s already been squawking @ AoA ( editor’s box) about old dads and heavy mothers. Whatever-isn’t-vaccines is not greetly too fondly at that location.

  7. Denice Walter April 10, 2012 at 17:36 #

    Oops! that should be *greeted*..

  8. Victoria Gillen April 10, 2012 at 18:05 #

    I admit I am committing a sin by commenting while not reading the study (school work trumps) – but autism incidence rates increasing and increasing obesity reminds me of the old top-hat as preventor of contagious disease: when you have enough money to buy a top hat you can afford to retire to your country estate during outbreaks.

  9. David N. Brown April 10, 2012 at 18:33 #

    This seems to be shaping up into one of the more unfortunate studies as far as public reaction. Last night, I saw a news “blurb” saying, “autism linked to overweight mothers”.

    To whatever extent there might be something to this, my guess is that the likeliest explanation is simply another case of “sub-threshhold” autistic symptoms being manifested in parents. I haven’t seen or heard anyone say as much, but there are certainly autistics who overeat, and it’s at the least conceivable that there is a genuine increased risk of obesity. At any rate, I think running down some hard numbers to address that question is far more worthwhile than trying to come up with a theory of a causal connection.

  10. daedalus2u April 11, 2012 at 01:32 #

    Sullivan, obesity is going up mostly in males? So is autism. Maybe the thing that is making obesity go up is the same thing that is making autism go up?

  11. Chris April 11, 2012 at 01:54 #

    Maybe the thing that is making obesity go up is the same thing that is making autism go up?

    Internet video games?

  12. stanley seigler April 11, 2012 at 02:44 #

    @daedalus2u: “the thing that is making obesity go up is the same thing that is making autism go up”

    realize i am out of my element with all the LBRB scientists…but surely d2u jest…then guess some made a similar jest comment when people said the earth revolved around the sun…

  13. David N. Brown April 11, 2012 at 08:27 #

    Sullivan,
    “Obesity is higher amongst older vs. younger women…”

    That would be quite sufficient to dispose of this tempest in a teapot. We already know that older women are more likely to have autistic children (which I think can be wholly accounted for as a “subthreshhold” phenomenon). If the same women are at higher risk of being overweight, then there should be no surprise or significance in finding a correlation of obesity and autism.

    David N. Brown
    Mesa, Arizona

  14. McD April 11, 2012 at 08:51 #

    While we are speculating, I note that they did not control for anti-depressant use.

    Which is unfortunate given the recent link between anti-depressants and autism:
    http://archpsyc.ama-assn.org/cgi/content/abstract/archgenpsychiatry.2011.73

    And the link between certain anti-depressants and obesity:
    http://onlinelibrary.wiley.com/doi/10.1111/j.1467-789X.2004.00139.x/abstract
    http://cat.inist.fr/?aModele=afficheN&cpsidt=18367468
    http://cat.inist.fr/?aModele=afficheN&cpsidt=23420167

    So I can’t see that they can separate out anti-depressant use from obesity, without specifically accounting and controlling for it, given the actual quite low numbers of kids they are talking about.

  15. daedalus2u April 11, 2012 at 18:36 #

    McD, maybe the same thing that causes depression also causes obesity and also causes autism?

  16. Science Mom April 11, 2012 at 19:38 #

    Good point McD, without controlling for potential confounders such as SSRIs, there is no way to tease out absolute effects of maternal obesity. I hope a larger study examining age (maternal and paternal), body type, medications, etc. will be conducted.

    • Sullivan April 11, 2012 at 20:40 #

      Science Mom, d2u, McD, et al:

      One question in my mind is a general question with CHARGE. We hear about “hits” they find. Freeways. Now obesity, hypertension and others.

      Are these really separate studies, or parts of a single study. To what extent are they doing a multi-factor search and, as such, should be using a more strict criterion for what constitutes statistical significance?

      Let’s say that they are monitoring 1,000 variables in the study. Pulling just the “hits” out isn’t the same thing as if they pose a single question (e.g. does proximity to a freeway confer autism risk?) in terms of whether the results are statistically significant.

  17. McD April 12, 2012 at 06:12 #

    Good point Sullivan, just by chance they are going to find a raft of statistically significant variables. Data-mining and reporting on post-hoc hypotheses is really dodgy. I hope that is not going on.

    Ideally the multitude of variables should be input for hypotheses they can then go on to test with new fresh data. Or they approach the data with a specific hypothesis and test only the one question, and ignore spurious results.

    I had a look at their publications page and they have publications listed on a variety of factors, including one on month of conception and risk of autism:
    Zerbo O, Iosif AM, Delwiche L, Walker C, Hertz-Picciotto I. Month of Conception and Risk of Autism. Epidemiology. 2011 Jul;22(4):469-75. PMID: 21543984
    http://www.ncbi.nlm.nih.gov/pubmed/21543984

    The odds ratio for a child conceived in December is a whopping 1.09 and kids conceived December to March have the same slightly increased chance of a diagnosis. I note this is in a huge 6yo cohort though, and I wonder if it could be an artefact of the time the child has been enrolled at school by the time the study had occurred. I wonder if the effect would wash out at the 8yo cohort. No one seems to have noticed the same conception month effect in the CDC data. At least they didn’t claim it had something to do with planetary alignment.

  18. stanley seigler April 12, 2012 at 06:44 #

    @du2: “… maybe the same thing that causes depression also causes obesity and also causes autism?

    as a non scientist…tend to agree…ponder…but think there is a chicken/egg component.

  19. McD April 12, 2012 at 07:24 #

    I have been gritting my teeth with nowhere to vent… it’s gotta come out…sorry if this sort of turns into a hijack.

    If nothing else, this study has brought out some bigots.

    Yesterday’s morning radio host had a field day with this one. He seems be to on a personal mission to vilify autistics and autism parents.
    http://en.wikipedia.org/wiki/Michael_Laws#Comments_on_theft_by_man_with_special_needs

    About two weeks ago, he was banging on about how autistic kids should not be mainstreamed, or at school at all, and should be kept away from his precious little flowers. The event he was opining on is here:
    http://www.stuff.co.nz/national/education/6558154/Court-fight-looms-over-rights-of-disabled

    He had his callers riled up at the utter injustice of their tax dollars going towards teacher’s aides, and some of the callers displayed some of the ugliest behavior I have heard coming from humans. He told a caller, but of course she should pay for a one-on-one teacher’s aide for her own child, and if parents could not afford that sort of money, too bad they should not have have kids in the first place. Most parents in NZ either have to part-fund a teacher’s aide themselves, or the kids attends school part-time. Actual behavior therapy is pie-in-the-sky unless you are a two professional income family.

    Ironically the talkshow host himself has a daughter who has leukaemia and then as she was recovering, fought off an aspergillus infection:

    http://www.stuff.co.nz/national/3594153/Joy-as-Lucy-Laws-chemo-treatment-finishes
    http://www.radiolive.co.nz/My-golden-girl-Lucy-makes-me-a-better-man-/tabid/430/articleID/12999/Default.aspx

    Her treatment of course – involving hundreds of specialist procedures – is fully funded by the taxpayer. You would think, reading his article above, he would have picked up a bit of sympathy for the parents of other kids with problems. But no – apparently it is a different story when the random mutation hits your synapses, rather than a part of your blood supply.

    So yesterday, he really went to town on this study. Not only can he vilify autistics and their parents, but ‘science’ is on his side. He obviously has no idea what odds ratios or risk factors mean. And he did his listeners a great dis-service by misleading them. Between the two recent shows, one would get the impression that autism parents are trailer-park trash looking to somehow cash in on their child’s disability (this is ironic tragedy in NZ, since autism causes way more financial devastation than otherwise); they are also just using the “autism” label to conceal children damaged by bad parenting.

    He actually said, yesterday, the increase in autism numbers recently was due to bad parents making their kids autistic, and “so-called Aspergers” are just badly behaved kids. On the days he is not having a direct go at Autistics, he refers to himself jokingly as “having AS”, as in “that is my Aspergers coming out” whenever he blurts out something rude or offensive he should not really say on air.

    The only positive is that, probably on the advice of the station’s lawyers, he has not made any of the recordings of the autism-related shows available for later listening, as often happens. He did get into a bit of trouble when he had a go at the Aspie with the light fitting obsession, who lifted a few light fittings from an abandoned and derelict building after the second earthquake, then got beaten up in police custody.

    I would really like to call in and ask him what is the difference between his child and mine, and why his child gets treatment and mine doesn’t. With treatment, my child has a good chance of being a taxpayer, without treatment, he would probably be a life-long beneficiary. We are paying ourselves, but it is like having a second mortgage. He didn’t have to take out a second mortgage for his daughter’s treatment. My husband and I spent 44 years in the Army between us paying taxes to fund his daughter’s treatment.

  20. Roger Kulp April 17, 2012 at 04:07 #

    As a followup on lilady’s post,we have this.
    http://www.sciencedaily.com/releases/2012/04/120409103942.htm

    I don’t think this was talked about here.My mother had gestational diabetes,while pregnant with my sister,who has both Asperger’s,and childhood onset diabetes.

Trackbacks/Pingbacks

  1. Autism Blog – Maternal Metabolic Conditions and Risk for Autism … | My Autism Site | All About Autism - April 10, 2012

    […] Read more: Autism Blog – Maternal Metabolic Conditions and Risk for Autism … […]

  2. Worth Repeating: Maternal Metabolic Conditions and Risk for Autism and Other Neurodevelopmental Disorders - April 11, 2012

    […] to our friends at Left Brain Right Brain for blogging about this […]

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