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Are Vitamin Supplements Used Before or During Pregnancy Associated With ASD Risk?

Summary: A new study backs previous findings, reporting a reduced risk of ASD in the offspring of mothers who used folic acid and multivitamins both prior to and during pregnancy.

Source: JAMA Psychiatry.

The use of folic acid and multivitamin supplements by women before and during pregnancy was associated with a lower likelihood of autism spectrum disorder in children but this finding needs to be interpreted with caution because other factors could explain it.

Why The Research Is Interesting: Maternal vitamin deficiency during pregnancy is associated in some studies with deficits in neural development in children; to avoid neural tube defects in their children, pregnant mothers are routinely recommended to take folic acid during pregnancy but study findings about an association between maternal use of folic acid and multivitamin supplements and risk of autism spectrum disorder (ASD) in children have been inconsistent.

Who and When: 45,300 Israeli children born between 2003-2007 and followed up to 2015

What (Study Measures): Maternal use of folic acid and multivitamin supplements before and during pregnancy (exposure); ASD (outcome). The association between maternal use of supplements and the likelihood of ASD in children was reported as a statistical measure known as relative risk (a relative risk less than 1 suggests less risk).

How (Study Design): This is a case-control cohort study, which is a type of observational epidemiologic study where children with an outcome (ASD) were compared to children without that outcome to identify exposures (maternal use of folic acid and multivitamin supplements) that may increase or protect against risk for ASD. Because researchers are not intervening for purposes of the study, they cannot control natural differences that could explain the study findings.

Image shows a baby and pills.

The association between maternal use of supplements and the likelihood of ASD in children was reported as a statistical measure known as relative risk (a relative risk less than 1 suggests less risk). NeuroscienceNews.com image is credited to JAMA Psychiatry.

Results: Maternal use of folic acid and multivitamin supplements before and during pregnancy appeared to be associated with a reduced risk for ASD in children compared with the children of mothers who did not use supplements.

Study Limitations: The authors cannot rule out that the risk reduction is due to other causes.

Study Conclusions: A reduced risk of ASD in children whose mothers used folic acid and multivitamin supplements before and during pregnancy could have important public health implications but more research is needed to examine this possible association.

About this neuroscience research article

Authors: Stephen Z. Levine, Ph.D., of the University of Haifa, Israel, and coauthors.

Source: Itai Shiner – JAMA Psychiatry
Publisher: Organized by NeuroscienceNews.com.
Image Source: NeuroscienceNews.com image is credited to JAMA Psychiatry.
Original Research: Full open access research for “Association of Maternal Use of Folic Acid and Multivitamin Supplements in the Periods Before and During Pregnancy With the Risk of Autism Spectrum Disorder in Offspring” by Stephen Z. Levine, PhD; Arad Kodesh, MD; Alexander Viktorin, PhD; Lauren Smith, BA; Rudolf Uher, MD, PhD; Abraham Reichenberg, PhD; and Sven Sandin, PhD in JAMA Psychiatry. Published online January 3 2018 doi:10.1001/jamapsychiatry.2017.4050

Cite This NeuroscienceNews.com Article
JAMA Psychiatry “Are Vitamin Supplements Used Before or During Pregnancy Associated With ASD Risk?.” NeuroscienceNews. NeuroscienceNews, 3 January 2018.
<http://neurosciencenews.com/pregnancy-vitamins-asd-8356/>.
JAMA Psychiatry (2018, January 3). Are Vitamin Supplements Used Before or During Pregnancy Associated With ASD Risk?. NeuroscienceNews. Retrieved January 3, 2018 from http://neurosciencenews.com/pregnancy-vitamins-asd-8356/
JAMA Psychiatry “Are Vitamin Supplements Used Before or During Pregnancy Associated With ASD Risk?.” http://neurosciencenews.com/pregnancy-vitamins-asd-8356/ (accessed January 3, 2018).

Abstract

Association of Maternal Use of Folic Acid and Multivitamin Supplements in the Periods Before and During Pregnancy With the Risk of Autism Spectrum Disorder in Offspring

Importance The association of maternal use of folic acid and multivitamin supplements before and during pregnancy with the risk of autism spectrum disorder (ASD) in offspring is unclear.

Objective To examine the associations between the use of maternal folic acid and multivitamin supplements before and during pregnancy and the risk of ASD in offspring.

Design, Setting, and Participants A case-control cohort study of 45 300 Israeli children born between January 1, 2003, and December 31, 2007, were followed up from birth to January 26, 2015, for the risk of ASD. The cases were all children diagnosed with ASD and the controls were a random sample of 33% of all live-born children.

Exposures Maternal vitamin supplements were classified for folic acid (vitamin B9), multivitamin supplements (Anatomical Therapeutic Chemical A11 codes vitamins A, B, C, and D), and any combination thereof exposed in the intervals before and during pregnancy.

Main Outcomes and Measures The association between maternal vitamin supplementation and the risk of ASD in offspring was quantified with relative risks (RRs) and their 95% CIs fitting Cox proportional hazards regression models adjusted for confounders. Sensitivity analyses were performed to test the robustness of the results.

Results Of the 45 300 children in the study (22 090 girls and 23 210 boys; mean [SD] age, 10.0 [1.4] years at the end of follow-up), 572 (1.3%) received a diagnosis of ASD. Maternal exposure to folic acid and/or multivitamin supplements before pregnancy was statistically significantly associated with a lower likelihood of ASD in the offspring compared with no exposure before pregnancy (RR, 0.39; 95% CI, 0.30-0.50; P < .001). Maternal exposure to folic acid and/or multivitamin supplements during pregnancy was statistically significantly associated with a lower likelihood of ASD in offspring compared with no exposure during pregnancy (RR, 0.27; 95% CI, 0.22-0.33; P < .001). Corresponding RRs were estimated for maternal exposure to folic acid before pregnancy (RR, 0.56; 95% CI, 0.42-0.74; P = .001), maternal exposure to folic acid during pregnancy (RR, 0.32; 95% CI, 0.26-0.41; P < .001), maternal exposure to multivitamin supplements before pregnancy (RR, 0.36; 95% CI, 0.24-0.52; P < .001), and maternal exposure to multivitamin supplements during pregnancy (RR, 0.35; 95% CI, 0.28-0.44; P < .001). The results generally remained statistically significant across sensitivity analyses.

Conclusions and Relevance Maternal exposure to folic acid and multivitamin supplements before and during pregnancy is associated with a reduced risk of ASD in the offspring compared with the offspring of mothers without such exposure.

“Association of Maternal Use of Folic Acid and Multivitamin Supplements in the Periods Before and During Pregnancy With the Risk of Autism Spectrum Disorder in Offspring” by Stephen Z. Levine, PhD; Arad Kodesh, MD; Alexander Viktorin, PhD; Lauren Smith, BA; Rudolf Uher, MD, PhD; Abraham Reichenberg, PhD; and Sven Sandin, PhD in JAMA Psychiatry. Published online January 3 2018 doi:10.1001/jamapsychiatry.2017.4050

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