Maternal Folic Acid Supplementation May Reduce Autism Risk

A new study suggests that folic acid supplementation during pregnancy may reduce the risk for autism in children.

Folate and folic acid are forms of the water-soluble B9 vitamin. Folate occurs naturally in food, and folic acid is the synthetic form of this vitamin. Folic acid is well-tolerated in amounts found in fortified foods and supplements. Sources of folate include cereals, baked goods, leafy vegetables (spinach, broccoli, lettuce), okra, asparagus, fruits (bananas, melons, lemons), legumes, yeast, mushrooms, organ meat (beef liver, kidney), orange juice and tomato juice. Folic acid is frequently used in combination with other B vitamins in vitamin B complex formulations.

Folic acid is strongly recommended by healthcare professionals at the start of pregnancy and even before conception. Folic acid is needed for the closing of fetus' neural tube. The neural tube is the fetus's precursor to the brain and spinal cord. Folic acid thus helps prevent spina bifida, a very serious birth defect.

In a recent study, researchers analyzed data from the Childhood Autism Risk from Genetics and Environment Study, including 429 families with an autistic child, 130 families with a child of delayed development and 278 families with a child of normal development. Data on maternal folic acid intake, including dose, brand and frequency of use, was collected through telephone interviews.

The researchers found that maternal folic acid intake was significantly higher during the first month of pregnancy for families with children of normal development when compared with families with an autistic child. Furthermore, an average of at least 600 micrograms of folic acid intake daily was linked to a reduced risk for autism. The authors noted that there was a trend toward a link between low folic acid intake during the first three months of pregnancy and having a child with delayed development; however, a significant link was lacking.

The authors concluded that high folic acid supplementation during pregnancy may reduce the risk for autism in children; however, further research is warranted before a strong conclusion can be made.

In addition to folate and other vitamins, minerals, such as calcium and iron, are particularly needed by the rapidly growing fetus. Pregnant women should eat enough dairy products (for calcium) and red meat (for iron) if they are not lactose intolerant or vegetarian. Women who do not eat dairy or meat can obtain calcium and iron from fortified soy milk and juice, soybeans and certain leafy greens. Calcium is effective only if women also obtain enough vitamin D. Vitamin D can be made in the body after exposure to ultraviolet rays from the sun or from food sources. Although milk is fortified with vitamin D, dairy products made from milk, such as cheese and ice creams, are generally not fortified with vitamin D. Cold water fish such as salmon, mackerel and sardines also good sources of vitamin D.

For more information about folate and folic acid, please visit Natural Standard's Foods, Herbs & Supplements Database.

Also try Natural Standard's NEW Pregnancy & Lactation Checker, an easy-to-use tool for consumers and healthcare professionals seeking safety data on integrative therapies for pregnant and breastfeeding women.

Comments

[ML]

I know that it is important for pregnant women to take folic acid supplementation. I wonder how much is considered “high” amounts of folic acid for the benefit. I also think that doing a telephone interview may be a limitation due to a possible incorrect patient recall. Also does delayed development definitely result in autism or can it mean other learning disabilities. I would like to know what they would find with a longer term study to evaluate the children in a school setting.

[BV]

I think this study is very interesting and helps shed light on the importance of folic acid supplementation for pregnant women. As "bz" mentioned in a previous comment, it is mainly touted for it's ability to prevent neural tube defects. I feel that folic acid supplementation is probably just one small piece of the puzzle in regards to preventing autism. It is important to note that the odds of having this disorder have been rising over the past 20+ years. I have talked to my elders who claim they don't remember growing up with autistic children in their schools, however it now seems that everyone you meet knows somebody who is affected by autism (friends or family). It is controversial whether or not this rise in autism is due to the increased awareness, vaccines, or other factors. However, I would be interested in seeing a study done on pregnant women who have an organic/natural diet free of GMO's versus women who have a diet that mainly includes GMO's and non-organic/natural foods. GMO's have remained very controversial since their introduction into our diets, and it seems that the time frame for GMO's and the rise in autism could be similar.

[Zach]

I agree with kl. There needs to be more solid education about vaccines. They are one of the most impactful inventions EVER. Check out this cool page that has some great tools for those of us who are visual:
http://www.historyofvaccines.org/
You can see that there have been several instances in history where vaccinations go down, and measles goes up.
The World Health Organization (WHO) estimates that 1.4 million deaths have been prevented by this vaccine. I think that's a pretty good trade off EVEN IF it causes a case or two of autism a year, which it doesn't.

[Sabrina]

I just skimmed through the study and one major flaw I see is that the overall diet of the mother's was not accessed. The only items analyzed was their intake of folic acid through multivitamins, pre-natal vitamins, folic-acid specific vitamins, cereals, and other supplements (such as shakes and bars). The diet of the mother's could significantly impact the results in this study. Another study should be completed and it should incorporate analyzing diet as well.

[MS]

As a pharmacy student I only knew the use of folic acid to avoid neural tube defect. Other factors should be considered when looking at autism like maternal stress, healthy diet, and many other things that may influence the fetus development. Vitamin D, calcium and folic acid are very important to supplement during pregnancy. It is very important that individuals who live in areas with less sun exposure, take active vitamin D supplements (calcitriol-also known as 1,25-dihydroxyvitamin D3). Individuals should make sure to look at the ingredients section of the vitamin D3 to make sure it is calcitriol and not any of the other forms which are inactive and are not useful in someone who does not have much exposure to the ultraviolet light to convert the inactive form of vitamin D to the active form in their body.

[bz]

I find a's comment very interesting, in that folic acid has an evidence grade of A for neural tube defect prevention but only an evidence grade of B for methotrexate toxicity. Folic acid is widely used for methotrexate toxicity, and is the mainstay of treatment for this type of toxicity. I wonder why they are not both evidence grade A.

[bz]

It is interesting to see there may be a link between folic acid supplementation during pregnancy and autism development. There seems to be so many factors involved in the development of autism that it seems impossible to say that folic acid is a definite factor, but nonetheless, supplementation is always important. I wonder if supplementation of the child after birth would further reduce the risk of developing autism?

[a]

According to the natural standard website, folic acid has an evidence grade of "A" for "strong scientific evidence" for use in pregnancy but it appears that most of the research is done for prevention of neural tube defects. I think it would make sense that it may have other beneficial effects (such as autism prevention) if taken during pregnancy. Other uses for folic acid that I found interesting were Methotrexate toxicity (evidence grade of B), Alzheimer's disease (evidence grade of C), Anemia (evidence grade of C), and depression (evidence grade of c).

[AM]

It is good that there is so much support for folic acid supplementation in pregnancy since it is apparent that it is accompanied with a lot of benefits. On NPR last week, I had also heard that there was a strong link between folic acid supplementation and lower risk of autism in the child--it appears that what stands in the way between getting full benefit of this supplementation is when it is started. The recommendation was to start taking the supplement 4 weeks before conception and to continue this for at least 8 weeks after becoming pregnant. For patients who had not planned to become pregnant, or have trouble with compliance, getting full benefit of the supplement may not be possible, but they should realize that it is important nonetheless.

[AR]

To me it sounds like there may be a correlation with folic acid intake of pregnant women and the risk of autism, but I think that the intake of other vitamins and minerals would have an effect on fetal development as well. The authors of the study even stated that the association between developmental delay and low folate intake in the three months prior to becoming pregnant no longer existed after the results were adjusted for confounding factors. This was a well done study, but it would be interesting to see a study where the intake of more vitamins and minerals was monitored and reported.

[bz]

I am surprised to see that there are women out there who are not getting enough folic acid whole pregnant. With all of the known benefits of folic acid supplementation during pregnancy, it is amazing to see that this information is not getting to enough women. We have a responsibility to these women as healthcare providers to emphasize the importance of folic acid supplementation, especially in terms of known risks such as neural tube defects. Every woman should be supplementing folic acid during pregnancy unless they have a serious contraindication.

[kl]

The risk of autism has also been associated with the MMR vaccine. Starting in 1998 with a publication by Andrew Wakefield in The Lancet, there has been controversy regarding the MMR vaccine and the development of autism. Since the MMR vaccine is usually given in two doses (the first at ages 12-15 months and the second at ages 4-6 years) and the second dose correlate to the time in which symptoms of autism may develop in children, a causative link was wrongly made between the two. For the most part this controversy has been resolved with the partial and then complete retraction of the original Lancet article, however some people still refuse to vaccinate their children for measles, mumps, and rubella viruses. According to the CDC, the "MMR vaccine is not responsible for recent increases in the number of children with autism". In order to keep the rate of mumps, measles, and rubella outbreaks at a minimum, it is essential for all children to complete this vaccination series.