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Is inflammation during pregnancy linked to autism?

Posted on: March 20, 2013   by  Dr William Grant

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By William Grant and John Cannell

There is a law called Occam’s razor, which is a principle of parsimony, economy, or succinctness used in logic and problem-solving. To quote Isaac Newton,

“We are to admit no more causes of natural things than such as are both true and sufficient to explain their appearances. Therefore, to the same natural effects we must, so far as possible, assign the same causes.”

Sometimes researchers don’t use Occam’s razor. Take the recent study finding that increasing maternal CRP levels are significantly associated with autism in the offspring.

Brown AS, Sourander A, Hinkka-Yli-Salomäki S, McKeague IW, Sundvall J, Surcel HM. Elevated maternal C-reactive protein and autism in a national birth cohort. Mol Psychiatry. 2013 Jan 22.

The authors suggested that CRP levels were elevated due to immune response to maternal infections triggering the autism. In this blog, we outline the evidence that maternal vitamin D deficiency may explain the elevated CRP levels, the maternal infections, and the autism.

In adults, CRP is inversely correlated with serum 25-hydroxyvitamin D [25(OH)D] for 25(OH)D levels <21 ng/ml.1 An analysis of data from NHANES III found that the mean serum 25(OH)D level for pregnant women during the first trimester of pregnancy in the United States was 23 ng/ml.2 Thus, many pregnant women have serum 25(OH)D levels <21 ng/ml.

As far as evidence that vitamin D deficiency is a risk factor for autism, the evidence is mounting. For example, there are generally excess birth rates for autism around March in the northern hemisphere3, a time when serum 25(OH)D levels are lowest. In addition, a recent ecological study of autism prevalence in the United States found significant inverse correlations with respect to solar UVB doses.4

Recently, Mostafa and colleagues found that autistic children had much lower vitamin D levels than healthy children (P<0.001), 14 ng/ml/L versus 33 ng/ml.5 Eighty percent of the typically developing children had levels above 30 ng/ml while only 12% of the autistic children had such levels. Second, they found that 25(OH)D levels were very highly negatively correlated with autism severity as measured by the Clinical Autism Rating Scale (R = -0.84). Finally, they found that 70% of autistic children had antibodies against their own brain tissue (anti-MAG autoantibodies), which were negatively correlated with vitamin D levels, the R value in this case was an amazing -0.86. CRP, a marker of inflammation, is elevated in many autoimmune disorders.

There are also recent reports of adverse neurological birth outcomes associated with low maternal 25(OH)D levels during pregnancy. One study in Australia found that maternal vitamin D deficiency (<18 ng/ml) during pregnancy was significantly correlated with language impairment in the offspring.6 A second study by the same group found that the offspring of mothers with serum 25(OH)D levels <20 ng/ml at the 18th week of pregnancy tested high on an Attention Switching subscale.7

As far as infection and vitamin D deficiency, two recent reviews made the case why a number of infectious diseases will be higher in the vitamin D deficient.8, 9 A study during the first trimester of pregnancy found that, compared with a serum 25(OH)D level of 30 ng/ml, there is a 1.65-fold increase in the prevalence of bacterial vaginosis associated with a maternal serum 25(OH)D level of 10 ng/ml.10

If Brown and colleagues could look at the data again and do 25(OH)D levels on the stored blood, they may likely demonstrate that maternal vitamin D deficiency is a risk factor for autism in the offspring. Pregnant women looking to avoid autistic offspring are well advised to take at least 4,000 IU/day of vitamin D3 or more and raise serum 25(OH)D levels above 40 ng/ml based on a randomized controlled trial with pregnant and nursing women in South Carolina. This study found beneficial effects during pregnancy and no adverse effects associated with 4000 IU/d vitamin D3.11 The 25(OH)D levels >40 ng/ml are required for full maternal ability to raise gestational serum 1,25-dihydroxyvitamin D to optimal levels.

Again, Occam’s razor dictates that among competing hypotheses, the one that makes the fewest assumptions should be selected. In medicine, diagnostic parsimony insists that when diagnosing a given disease a doctor should strive to look for the fewest possible causes that will account for all the facts. Occam’s razor shouts out that maternal vitamin D deficiency explains the elevated CRP, the infections and the autism.

References

1. Amer M, Qayyum R. Relation between serum 25-hydroxyvitamin D and C-reactive protein in asymptomatic adults (from the continuous National Health and Nutrition Examination Survey 2001 to 2006). Am J Cardiol. 2012;109:226-230.

2. Ginde AA, Sullivan AF, Mansbach JM, Camargo CA Jr. Vitamin D insufficiency in pregnant and nonpregnant women of childbearing age in the United States. Am J Obstet Gynecol. 2010;202:436.e1-e8.

3. Grant WB, Soles CM. Epidemiologic evidence for supporting the role of maternal vitamin D deficiency as a risk factor for the development of infantile autism. Dermatoendocrinol. 2009;1:223-228. Erratum, 2009:1:315.

4. Grant WB, Cannell JJ. Autism prevalence in the United States with respect to solar ultraviolet-B doses: An ecological study. Dermatoendocrinol. 2012;5(1): epub December 2012

5. Mostafa GA, Al-Ayadhi LY. Reduced serum concentrations of 25-hydroxy vitamin D in children with autism: relation to autoimmunity. J Neuroinflammation. 2012;9:201.

6. Whitehouse AJ, Holt BJ, Serralha M, Holt PG, Kusel MM, Hart PH. Maternal serum vitamin D levels during pregnancy and offspring neurocognitive development. Pediatrics. 2012;129:485-493.

7. Whitehouse AJ, Holt BJ, Serralha M, Holt PG, Hart PH, Kusel MM. Maternal vitamin D levels and the autism phenotype among offspring. J Autism Dev Disord. 2012 Oct 16. [Epub ahead of print]

8. Jolliffe DA, Griffiths CJ, Martineau AR. Vitamin D in the prevention of acute respiratory infection: Systematic review of clinical studies. J Steroid Biochem Mol Biol. 2012 Dec 7.

9. Lang PO, Samaras N, Samaras D, Aspinall R. How important is vitamin D in preventing infections? Osteoporos Int. 2012 Nov 17.

10. Bodnar LM, Krohn MA, Simhan HN.Maternal vitamin D deficiency is associated with bacterial vaginosis in the first trimester of pregnancy. J Nutr. 2009;139:1157-1161.

11. Hollis BW, Johnson D, Hulsey TC, Ebeling M, Wagner CL. Vitamin D supplementation during pregnancy: double-blind, randomized clinical trial of safety and effectiveness. J Bone Miner Res. 2011;26:2341-2357.


5 Responses to Is inflammation during pregnancy linked to autism?

  1. Rita and Misty

    I know some readers disagree with Dr. Mercola; however I do enjoy his website, and I find his work informative:

    http://articles.mercola.com/sites/articles/archive/2011/05/12/does-inflammation-play-a-role-in-autism.aspx

    🙂 Be well!

  2. Rita and Misty

    From Yale University (April 25, 2013):

    (NOTE from me to Drs. Cannell & Grant, VDC staff and members: How I wish that someone here would consider checking the 25(OH)D levels of expectant mothers and treat for deficiency…better yet: treat to raise vitamin d serum level to 50 ng/ml…but this might just be too simple a solution, huh?…very frustrating…)

    http://news.yale.edu/2013/04/25/autism-risk-spotted-birth-abnormal-placentas

    “Currently, the best early marker of autism risk is family history. Couples with a child with autism are nine times more likely to have another child with autism. Kliman said that when these at-risk families have subsequent children they could employ early intervention strategies to improve outcomes. ‘Regrettably couples without known genetic susceptibility must rely on identification of early signs or indicators that may not overtly manifest until the child’s second or third year of life,’ said Kliman.

    ‘I hope that diagnosing the risk of developing autism by examining the placenta at birth will become routine, and that the children who are shown to have increased numbers of trophoblast inclusions will have early interventions and an improved quality of life as a result of this test,’ Kliman added.”

  3. Rita and Misty

    Whitehouse AJ, Holt BJ, Serralha M, Holt PG, Hart PH, Kusel MM. Maternal vitamin D levels and the autism phenotype among offspring. J Autism Dev Disord. 2012 Oct 16. [Epub ahead of print]

    http://link.springer.com/article/10.1007%2Fs10803-012-1676-8

    (this link should also provide full-text pdf; if not email me at rita.umile@yale.edu)

    From the above blog:

    “A second study by the same group found that the offspring of mothers with serum 25(OH)D levels <20 ng/ml at the 18th week of pregnancy tested high on an Attention Switching subscale."

    If you take the time to read the study, you will see that from the 929 offspring for whom maternal 25(OH)D data were available, ONLY 3 children received a diagnosis of ASD. Maternal 25(OH)D level at 18 weeks of pregnancy for these 3 males were 78, 65 and 63 nmol/L. These are low vitamin D serum levels by VDC reference range, but they were above the sample mean of 58.02 nmol/L).

    In my opinion, these researchers MISSED a remarkable piece of the puzzle by not testing the 25(OH)D levels of the offspring upon birth…perhaps for some reason not all children absorb sufficient amounts of D from their moms during pregnancy….

    Or perhaps I am missing something…and if so, please give me a clue…

    Thanks.

  4. Rita and Misty

    **Indeed to belabor my above comment…perhaps if a newborn’s 25(OH)D level is very low it might be due to a diseased placenta, containing multiple trophoblast inclusions, which might hinder nutrients properly reaching the fetus. (I’m not trained in medical terminology, so please excuse any errors on my part here…)

    So really upon birth, if the placenta is diseased, why not simply test the infant’s 25(OH)D level and if deficient, correct it?

    Simple enough to do, right? And doesn’t every human being need an optimal vitamin D blood serum level?

    Of course this would require a consensus within the medical community regarding a 25(OH)D level deemed optimal for human beings….

    A feel so very clueless here.

    🙁

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