We are now fairly certain that autism spectrum disorder (ASD) has both an environmental and a genetic component. The data involved both fraternal and identical twins (dizygotic and monozygotic twins) in California. The study under the leadership of Dr. Hallmayer of Stanford (with some 15 co-researchers) was published in Archives of General Psychiatry. The potential population involved some 1156 pairs of twins in total, but some could not be contacted and some declined participation; of the 333 pairs that remained, 202 were assessed. What makes this study interesting is that it was fairly diverse across ethnicity and socioeconomic factors.
If ASD were strictly genetic, one would expect that if one twin manifested the disorder, both would. If ASD were strictly environmental, then the disorder would be found in similar rates between the groups of fraternal and identical twins. Studies such as this could lend further credence to another hypothesis- that of fetal (or prenatal) programming. This hypothesis posits that embryo development and physiological development can be reset by environmental events (enduring into adulthood- even unto the next generation).
The Hallmayer study results indicated that about 50% of the risk towards manifesting ASD was due to environmental factors. The environmental factors include low birth rate, parental age, maternal infections- and possibly the use of antidepressants during pregnancy.
That latter finding is the result of a second publication in the same journal. Drs. Croen, Grether and Hendric along with Ms. Yoshida and Odouli studied 298 children with ASD (and their mothers), along with 1507 randomly selected controls (and their mothers), who were treated as Kaiser Permanente Medical (Northern California).
This study was developed because the use of antidepressants in pregnant women is increasing (from 5% during 2000-2 to 7.5% during 2006-8; which is up further from 1990, when less than 1% took antidepressants during the first trimester). These results are very troubling- if a mother took antidepressants anytime during the year before pregnancy, the risk of having a child with ASD doubled; it tripled if the mother took the medication during the first trimester. The particular antidepressants in this study were SSRI (selective serotonin reuptake inhibitors). Furthermore, there was NO relationship between a mother’s mental state, only with the use of antidepressants.
It should be noted that this is NOT causality, but correlation. It is entirely possible that this could be a genetic predisposition to a multitude of conditions. However, without additional information, it would be wise to preclude the use of antidepressants if one is dedicated to becoming pregnant.
No children for me then.
Janine:
1. Wait till you see the post (that I thought had already seen the light of day) https://www.adjuvancy.com/wordpress/?p=3700.
2. I think WAITING is a bigger issue!!! I don’t know how old your SO is, but given the fact that we are all getting longer in the tooth, the longer we wait, the more likely. And, perhaps, you should start taking prenatal vitamins now- for about 90 days- and then reconsider your refusal to join the parental chase. (Keep taking them for at least the first 120 days of pregnancy, too!) [https://www.adjuvancy.com/wordpress/http:/www.adjuvancy.com/wordpress/autism-vitamins-gene-expression-link/]
Thanks for dropping in.
Roy
Hmm. I would love to see more studies in this area. There’s always a lot of discussion about the increase in ASD and why that’s the case (is it that we’re more aware, is it because we’re now looking at the spectrum and therefore diagnosing more cases, is it because of increased chemicals in the environment or in our food, etc.). The increased use of antidepressants by mothers is really interesting and could explain things if it’s proven that it’s a cause.
Leanne:
We are available, if you wish to retain our services :-).
I think there are other issues that may prevail over antidepressants– waiting longer to get married and to have children, is one that certainly comes to mind.
Thanks for dropping in and leaving a comment!
Roy
Great post! Autism is definitely a complex disorder to understand.
Nisha-
You said a mouthful! And, a complex upbringing issue for parents!
Roy
The Autism debate! Though the use of anti depressants was something we debated in college about; their negative effects during pregnancy couldn’t be ignored. Also, in a place where over the counter drugs are available without necessarily having a prescription, things like this should be bought in the limelight.
Hope you have a lovely weekend!
Thanks for your comments, Hajra…
The real problem is – if they are causative- how does one know they will be pregnant within a year, unless one is planning. And, then if it takes a while to become pregnant, there may be long periods sans medication. But… since we see from another post (darn- it’s not been posted yet- maybe next week https://www.adjuvancy.com/wordpress/?p=3700) that they really don’t do anything….
I guess I’ll have to finish this answer when that post edges its way out of the queue….
Roy
Very interesting study Roy, I know many people worry since no one knows what causes the disorder. Do we really know how drugs and medications affect the DNA in the unborn? No, we only know what we are told or has been studied and the facts that come from those studies. This can be seen with the birth control drug Yasmin (Yaz), it was out in the market and considered safe, but then it turns out that the drug causes blood clots and Deep Vein Thrombosis. Like you state above this study shows that ASD has both genetic and environmental factors, thanks for sharing : )
Karla:
That is, indeed, one of the big problems with drug testing. We (I cannot escape this fact) choose our test panels based upon our ideal candidates for the drug. Then, we test the results. Then, different people take the drug than our ideal candidates. And, when we test 1000, the usage is for 1,000,000 or more. So, a rarely seen malady (which could be an anomaly) in 1000 gets amplified by 1000! (A 1 in 500,000 chance will rarely be seen in a clinical trial). And, docs prescribe them for other maladies for which we did not test.
You can see how this goes…
Thanks for your comments. Please drop in again- SOON!
Roy
Very interesting, Roy. I didn’t know that antidepressants were a possible reason for autism. Thank you for sharing!
I am not sure we can say that, Sherrie. We can say they correlate. And, they may, indeed, be an environmental factor. But, for now, we have no causation.
Thanks for dropping in!
Roy
I remember seeing a TV interview I think with Jim Carey and his wife and the comment that the medical profession did not know how to deal with autism let alone what caused it. I still come from a belief that you talk to a doctor about your symptoms then look to nature for a solution – stay off the drugs. Watch what you eat and listen to your body, especially during pregnancy.
Roberta:
Love your last sentence! That’s the key…
Roy
Interesting correlation of study results you have presented Roy about autism. It is certainly something that seems to be increasing as just about everyone knows a child on the autism spectrum.
I think our environment is just so toxic its no wonder we are falling prey to all number of different conditions as a result.
I believe pregnancy should be completely drug free wherever possible, unless it proves absolutely necessary. The unborn child is completely at the mercy of its mother for all its care and nutrients. I find it fascinating that external factors such as maternal stress can also affect the unborn baby – something I found out first hand with the birth of my youngest son.
Thanks again Roy for raising such important issues. Congratulations also for putting it in language much easier to understand.
Maureen-
Thanks for dropping in and your wonderful comments. So far, the only “drug” that seems to be of import for pregnancy is prenatal vitamins (one of the few times that vitamins really have benefit, besides).
And, as you implied, if we don’t spend some time AND money insuring our environment is safe, we are bound to find many maladies that either are the direct result or exacerbated by the various elements we fail to control.
Roy
Really interesting post Roy. You really did your homework on this one. The statistics tell a story but what the answers are, it is frustrating. It just seems that you hear more and more about families dealing with autism.
Thanks, Lynn.
This is a recurring topic on my blog, along with other maladies that affect our brain function.
Thanks for visiting!
Roy
It’s great to have it be confirmed like this, Roy. It can often be difficult for parents to handle the uncertainty, feeling like it’s out of their control (nature) or feeling like they did something wrong (nurture). Thanks for laying it all out so clearly! Shared! =)
Thanks for sharing, Samantha!
There’s lots of new data that I will be adding, too. A lot of new research, but not a great deal of thought into the ramifications. Trying to determine the best way to provide the information to the general public.
Thanks for visiting.
Roy
Wow great post!
I have an 18 year who was diagnosed with Autism at age 3. Luckily he has responded very well to treatment; he does have some autistic tendencies but it is mostly manifested through he receptive language comprehension. I also believe that some people in my family have similar tendencies yet they were never diagnosed. That study is very interesting! I didn’t take the SSRI before I was pregnant but did after my son was born. When he was born my son had a hard time catching his breath; he kept coughing and was put in the NICU unit for a day. I often wonder if that is related, but in the end; I just was grateful he was healthy overall. Yet, something more is going on with the rise of diagnosis then just better diagnostic instruments. Thanks for sharing!
Maureen:
There are all sorts of new programs and testing now. I am so glad your son responded well.
We will never completely know how or why some of our children develop ASD or other syndromes. Nor, do I personally thing that is helpful OR healthful.
Better to insure our children get the best they can from us- and their providers. Insure they have the best foundation possible.
Thanks for sharing- all the thoughts!
Roy