Asthma and Autism

  In The Politics of Autism, I discuss various ideas about what causes the condition. 

Jan Green at Kaiser Permanente:

Mothers with asthma or obesity during pregnancy had higher rates of children diagnosed with autism, according to a new Kaiser Permanente analysis published in the journal Biological Psychiatry: Global Open Science.

The study adds to evidence that maternal inflammation could affect neurodevelopment in children, said study lead author Lisa Croen, PhD, a senior research scientist and director of the Autism Research Program in the Kaiser Permanente Division of Research.


“There have been studies showing that conditions during pregnancy, such as obesity, infection, fever, and gestational diabetes are related to autism,” Croen said. “We wanted to look at these factors both individually and in combination to find out if there is a profile of mothers who have a higher likelihood of having an autistic child.”

The analysis found mothers with asthma were 62% more likely to deliver an infant later diagnosed with autism spectrum disorder; developmental disabilities were 30% more likely. In mothers with obesity, autism was 51% more likely, and risk increased with extreme obesity.

The association with autism was even stronger among mothers with both asthma and obesity.

There is a very long and growing list of other correlates, risk factors, and possible causes that have been the subject of serious studies: 

1. Inflammatory bowel disease;
2. Pesticides;
3. Air pollution and proximity to freeways;
4. Maternal thyroid issues;
5. Autoimmune disorders;
6. Induced labor;
7. Preterm birth;
8. Fever;  
9. Birth by cesarean section;
10. Anesthesia during cesarean sections;
11. Maternal and paternal obesity;
12. Maternal diabetes;
13. Maternal and paternal age;
14. Grandparental age;
15. Maternal post-traumatic stress disorder;
16. Maternal anorexia;
17. Smoking during pregnancy;
18. Cannabis use during pregnancy;
19. Antidepressant use during pregnancy;
20. Polycystic ovary syndrome;
21. Infant opioid withdrawal;
22. Zinc deficiency;
23. Sulfate deficiency;
24. Processed foods;
25. Maternal occupational exposure to solvents;
26. Congenital heart disease;
27. Insufficient placental allopregnanolone.
28. Estrogen in the womb;
29. Morning sickness;
30. Paternal family history;
31. Parental preterm birth;
32. Antiseizure meds
33. Location of forebears
34. Lithium
35. Aspartame
36. BPA
37. Brain inflammation

 

Obesity and Overweight

 In The Politics of Autism, I discuss the health problems of people on the spectrum.  Studies indicate that autistic people are prone to overweight and low physical activity levels.  At Nature, Robyn P. Thom and colleagues have an article titled "Prevalence and factors associated with overweight, obesity, and hypertension in a large clinical sample of adults with autism spectrum disorder."  The abstract:

Adults with autism spectrum disorder (ASD) are at risk for excess bodyweight and hypertension, yet the prevalence of and clinical predictors for these health conditions remain unknown. The objective of this study was to assess the prevalence of overweight, obesity, and hypertension in a large clinical sample of adults with a confirmed diagnosis of ASD and to examine potential clinical predictors. This retrospective chart review study included adult subjects (≥ 20 years) with ASD who had been seen within the past 5 years at a multidisciplinary developmental disorders clinic. Data collected from the electronic health record included age, sex, race and ethnicity, cognitive ability, language ability, body mass index (BMI), hypertension, and use of second generation antipsychotic medications (SGAs). Of 622 adults with a confirmed diagnosis of ASD potentially eligible for the study, 483 (78%) had one or more notes in their records from the past 5 years. Those with recent notes were 23% female, 89% White, and had a mean (SD) age of 28.1 (7.1) years. Overall prevalence estimates for adults represented by this predominantly male, White, and young clinical sample were 28% (95% CI 24%, 32%) for overweight (BMI 25–29.9 kg/m2), 35% (95% CI 31%, 40%) for obesity (≥ 30 kg/m2), and 11% (95% CI 9%, 15%) for hypertension. Controlling for age and sex, intellectual disability (ID) was significantly associated with BMI (p = 0.003) but not hypertension (p = 0.69); those with moderate or more severe ID had a mean BMI that was 2.26 kg/m2 (95% CI 0.96, 3.57) lower than those with no ID. Controlling for age and sex, neither language ability, Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) subtype of autism, nor past or current use of SGAs were significantly associated with BMI or hypertension. The study identified a high prevalence of overweight and obesity in adults with ASD consistent with the prevalence of these medical comorbidities in the U.S. population.

Autism Fitness Programs

In The Politics of Autism, I discuss the health problems of people on the spectrum.  Yesterday's post discussed the problem of obesity and physical inactivity.  Here are a couple of efforts to address the problem.

Kayla Burton reports at WGGB-TV:

The Holyoke Public School system hosting an autism fitness certification class this weekend meant to help people off all ages with the disorder.

While many autism programs address the cognitive side of autism, Founder, Eric Chessen, told Western Mass News the goal of this program is take on the physical health of those with the disorder.

"It's not just for highly motivated individuals who are below 12 years in age this is really for, everyone and what we're looking at is fitness as a gateway as optimal development to other areas," Chessen said.

The Autism Fitness Program was developed roughly 15 years ago.

FROM 2018: Dion Lim at KGO-TV in San Francisco:

Puzzle Piece Athletics is a first-of-its-kind gym in the Bay Area serving kids with autism. With hard work, determination, encouragement, and a special compassion lives are changed.

RELATED: New Bay Area gym specializes in CrossFit training for kids with autism

Join us as we introduce you to some of the wonderful people working out their muscles of happiness and hope.

For more information about Puzzle Piece Athletics, you can visit their Facebook and Instagram pages.

Obesity and Low Physical Activity are Problems for ASD Adolescents

In The Politics of Autism, I discuss the health problems of people on the spectrum.

Stephanie M McCoy and Kristen Morgan have an article at Autism titled "Obesity, Physical Activity, and Sedentary Behaviors in Adolescents with Autism Spectrum Disorder Compared with Typically Developing Peers." The abstract:

Decreased engagement in beneficial physical activity and increased levels of sedentary behavior and unhealthy weight are a continued public health concern in adolescents. Adolescents with autism spectrum disorder may be at an increased risk compared with their typically developing peers. Weekly physical activity, sedentary behavior, and body mass index classification were compared among adolescents with and without autism spectrum disorder. Analyses included 33,865 adolescents (autism spectrum disorder, n = 1036) from the 2016–2017 National Survey of Children’s Health (United States). After adjustment for covariates, adolescents with autism spectrum disorder were found to engage in less physical activity and were more likely to be overweight and obese compared with their typically developing peers (p’s < 0.05). As parent-reported autism spectrum disorder severity increased, the adjusted odds of being overweight and obese significantly increased and physical activity participation decreased (p-for-trends < 0.001). The findings suggest there is a need for targeted programs to decrease unhealthy weight status and support physical activity opportunities for adolescents with autism spectrum disorder across the severity spectrum.

Food selectivity and medication, the article suggests, may contribute to the problem.  People with ASD may have a hard time maintaining a healthy diet because of aversions to fruits and vegetables.  Medications such as reprisperidone and aripiprazole lead to weight gain. Physical activity is also a challenge:

Engaging in physical activity and team sports (e.g. football and soccer), requires a more advanced level of motor skills. However, it has been shown that both children and adolescents with ASD have deficits in motor skills ... Furthermore, team sports and physical activities become more competitive as children get older. The competitive atmosphere may be less conducive to adolescents with ASD compared with their typically developing peers (Nicholson, Kehle, Bray, & Heest, 2011). Another aspect of physical activity and sport that may contribute to decreased participation for adolescents with ASD is the social aspect. Fewer adolescents with ASD feel that sport and exercise are good ways to make friends (68% vs 97%, p<0 .001="" 2015="" adolescents="" al.="" blockquote="" comparison="" developing="" et="" in="" tanish="" typically="" with="">

Environmental Risks

In The Politics of Autism, I discuss various ideas about what causes the condition.

Here is just a partial list of correlates, risk factors, and possible causes that have been the subject of serious studies:

• Pesticides;
• Air pollution and proximity to freeways;
• Maternal thyroid issues;
• Autoimmune disorders;
• Induced labor;
• Preterm birth;
• Birth by cesarean section;
• Maternal and paternal obesity;
• Maternal and paternal age;
• Maternal post-traumatic stress disorder;
• Smoking during pregnancy;
• Antidepressant use during pregnancy. 

At STAT, Alycia Halladay writes:

A mountain of research has been conducted and published on a possible link between vaccines and autism, with hundreds of advocacy and scientific organizations refuting it. They also point out the public health risk of avoiding vaccinations. Yet the fear this unsubstantiated link has generated has led to the re-emergence of vaccine-preventable diseases such as measles and pertussis. Another consequence of the ongoing media attention paid to the issue is a misunderstanding of the real environmental risk factors associated with autism.

... 

Here are a few examples of environmental factors that that have been linked to autism:

• Exposure to the anti-epileptic drug valproic acid during pregnancy
• Older age of the mother or father
• High levels of air pollution during pregnancy. This association has been subjected to a systematic review and withstood scientific rigor. Genes control this association.
• Extreme illness or infection during pregnancy, including severe reactions to bacterial and viral infections (some of which can be prevented through vaccination)
• Obesity during pregnancy, premature birth, and complications during birth, likely as the result of interactions with genes

Exposure to these factors elevates a child’s risk of developing autism anywhere between two and four times. An exhaustive review of these factors was just published in the Annual Review of Public Health.

Update on Causes and Correlates

In The Politics of Autism, I discuss various ideas about what causes the condition.

Here is just a partial list of correlates, risk factors, and possible causes that have been the subject of serious peer-reviewed studies:

• Pesticides;
• Air pollution and proximity to freeways;
• Maternal thyroid issues;
• Autoimmune disorders;
• Induced labor;
• Preterm birth;
• Birth by cesarean section;
• Maternal and paternal obesity;
• Maternal and paternal age;
• Maternal post-traumatic stress disorder;
• Smoking during pregnancy;
• Antidepressant use during pregnancy. 

Lisa Rapaport reports at Scientific American:

Mothers who are obese during pregnancy have almost twice the odds of having a child with autism as women who weigh less, a U.S. study suggests.

When women are both obese and have diabetes, the autism risk for their child is at least quadrupled, researchers reported online January 29 in Pediatrics.

"In terms of absolute risk, compared to common pediatric diseases such as obesity and asthma, the rate of autism spectrum disorder (ASD) in the U.S. population is relatively low, however, the personal, family and societal impact of ASD is enormous," said senior study author Dr. Xiaobin Wang, a public health and pediatrics researcher at Johns Hopkins University in Baltimore.

A release from Drexel University:

 By comparing birth records over a period of nine years, Drexel researchers found that the children of mothers who took a certain asthma medication during pregnancy faced an elevated risk of being diagnosed with autism spectrum disorder.

"Since the teratogenic [an agent which could cause development issues in a fetus] potential of most drugs with respect to neurodevelopmental outcomes is generally understudied, I would hope my research would encourage more researchers to explore prescription drug use as a potential autism spectrum disorder risk factor," said Nicole Gidaya, PhD, a doctoral alum of Drexel's Dornsife School of Public Health and the lead author of the study.

Looking at birth records from Denmark dating between 1997 and 2007, it was determined that children whose mothers took ß-2-andrenergic receptor (B2AR) agonist drugs during pregnancy were 30 percent more likely to be eventually diagnosed with autism spectrum disorder.

The study, "In Utero Exposure to ß-2-Andregenic Receptor Agonist Drugs and Risk for Autism Spectrum Disorders," was published in the February issue of Pediatrics.

A release from MIT:

In 2010, a large study in Denmark found that women who suffered an infection severe enough to require hospitalization while pregnant were much more likely to have a child with autism (even though the overall risk of delivering a child with autism remained low).

Now research from MIT, the University of Massachusetts Medical School, the University of Colorado, and New York University Langone Medical Center reveals a possible mechanism for how this occurs. In a study of mice, the researchers found that immune cells activated in the mother during severe inflammation produce an immune effector molecule called IL-17 that appears to interfere with brain development.

The researchers also found that blocking this signal could restore normal behavior and brain structure.

“In the mice, we could treat the mother with antibodies that block IL-17 after inflammation had set in, and that could ameliorate some of the behavioral symptoms that were observed in the offspring. However, we don’t know yet how much of that could be translated into humans,” says Gloria Choi, an assistant professor of brain and cognitive sciences, a member of MIT’s McGovern Institute for Brain Research, and the lead author of the study, which appears in the Jan. 28 online edition of Science.

Obesity

In The Politics of Autism, I discuss the health problems of people on the spectrum.

At Pediatrics, Alison Presmanes Hill, Katharine E. Zuckerman, and Eric Fombonne have an article titled "Obesity and Autism."  The abstract:

OBJECTIVE: Overweight and obesity are increasingly prevalent in the general pediatric population. Evidence suggests that children with autism spectrum disorders (ASDs) may be at elevated risk for unhealthy weight. We identify the prevalence of overweight and obesity in a multisite clinical sample of children with ASDs and explore concurrent associations with variables identified as risk factors for unhealthy weight in the general population.

METHODS: Participants were 5053 children with confirmed diagnosis of ASD in the Autism Speaks Autism Treatment Network. Measured values for weight and height were used to calculate BMI percentiles; Centers for Disease Control and Prevention criteria for BMI for gender and age were used to define overweight and obesity (≥85th and ≥95th percentiles, respectively).

RESULTS: In children age 2 to 17 years, 33.6% were overweight and 18% were obese. Compared with a general US population sample, rates of unhealthy weight were significantly higher among children with ASDs ages 2 to 5 years and among those of non-Hispanic white origin. Multivariate analyses revealed that older age, Hispanic or Latino ethnicity, lower parent education levels, and sleep and affective problems were all significant predictors of obesity.

CONCLUSIONS: Our results indicate that the prevalence of unhealthy weight is significantly greater among children with ASD compared with the general population, with differences present as early as ages 2 to 5 years. Because obesity is more prevalent among older children in the general population, these findings raise the question of whether there are different trajectories of weight gain among children with ASDs, possibly beginning in early childhood.

At The Portland Business Journal, Elizabeth Hayes reports:

As to why children with autism may be at elevated risk, future studies will have to answer that, Hill said.

“I think there are a few interesting avenues for future research,” Hill said. “There are definitely some possibilities we weren’t able to explore.”

Hill said there could be a biological basis, or perhaps behaviors associated with the condition lead to weight problems.

“Some symptoms that might be manifested, like social withdrawal and increased sedentary behaviors, may be exacerbating weight gain among these kids,” Hill said. “It might be children with autism have fewer opportunities for active social play and behavioral challenges. They may have preferences for foods that are energy dense but not nutrient dense, and they may be picky eaters.

Perhaps One Risk Factor to Remove from the Long List

Rachel Zamzow reports at SFARI:

Women who are overweight during pregnancy have an increased risk of having a child with autism. But genetics, not the obesity per se, may underlie the association, according to a study published 4 June in the International Journal of Epidemiology 1.

The study is the largest to date to point to maternal weight as a factor in autism 2,3.
It found that being overweight during pregnancy does not track with autism when researchers analyze pregnancies in only women who have both affected and unaffected children. The researchers defined ‘overweight’ as having a body mass index (BMI) between 25 and 30.

“When we looked at our data we were actually very, very surprised to see that the association with the maternal BMI had completely gone away,” says lead researcher Renee Gardner, assistant professor of public health sciences at the Karolinska Institute in Sweden. “It was a surprise that really forced a change of perspective.”

More likely, she says, maternal weight is a marker for a genetic contributor to autism.

Health Problems of Autistic Adults

AP reports:

Autistic adults are much more likely than others to suffer from depression, high blood pressure, obesity and additional health woes that may partly result from their social isolation, new research suggests.

They’re also much less likely to smoke and drink alcohol, a paradoxical finding since those habits can contribute to many conditions that disproportionately affect autistic adults. Scientists say that could mean that their biologic makeup contributes to some of the illnesses.

The study is one of the largest, most comprehensive efforts to examine the health of autistic adults and highlights a need for better strategies to treat them, said scientist Lisa Croen, the lead author and director of the autism research program at Kaiser Permanente Division of Research in Oakland, California.
...
Some common features, including lack of eye contact and social awkwardness, might suggest that people with autism dislike human contact. But Croen said it’s more likely that they share a desire to connect with other people but have trouble doing so. That isolation could lead to problems like depression, she said.

Croen said isolation might also at least partly explain the lower rates of drinking and smoking, since those are social activities.

The abstract:

Psychiatric and Medical Conditions Among Adults with ASD
L. A. Croen, O. Zerbo, Y. Qian and M. L. Massolo, Division of Research, Kaiser Permanente Northern California, Oakland, CA

Background: Children with autism spectrum disorders (ASD) have been shown to have a higher burden of medical and psychiatric comorbidities and increased utilization of health care services compared to the general pediatric population. However, very little is known about the general health status among the adult ASD population. Given that increasing numbers of children are entering adulthood each year with an ASD diagnosis, an understanding of this issue is critical for resource planning and the development of effective strategies for health care delivery to adults with ASD.

Objectives: To describe the frequency of psychiatric and medical conditions among a large, diverse, insured population of adults with ASD in the US.

Methods: The study population was drawn from the adult membership (≥ 18 years) of Kaiser Permanente Northern California (KPNC) (~2.5 million) enrolled in the health plan for at least 9 months each year from 2008-2012. Physician documented diagnoses routinely captured in KPNC electronic medical records were utilized for all analyses. ASD cases (N=2,108) were adults with at least one ASD diagnosis (ICD-9-CM 299.0-299.8) recorded by December 2012. A control group of adults without any ASD diagnoses (N=21,080) were sampled at a 10:1 ratio and frequency matched to cases on total length of KPNC membership, sex, and age. We compared the prevalence of psychiatric, behavioral, and medical conditions overall and by sex, age group, and race/ethnicity between cases and controls.

Results: Adults with ASD had significantly increased rates of depression (38% vs. 17%), anxiety (39% vs. 18%), bipolar disorder (8% vs. 1%), and suicide attempts (1.6% vs. 0.3%), and prevalence differences between cases and controls increased with age. Among women, rates of alcohol and chemical dependency were 2-fold higher in ASD cases than controls. Nearly all medical conditions were significantly more common in adults with ASD than controls: diabetes (6% vs. 4%), gastrointestinal disorders (47% vs. 38%), epilepsy (12% vs. 1%), sleep disorders (19% vs. 10%), dyslipidemia (26% vs. 18%), hypertension (27% vs. 19%), and obesity (27% vs. 16%). Among women, asthma, allergy and autoimmune disorders were present 20%-30% more often in adults with ASD than controls. Rarer conditions, such as eating disorders, mechanical falls, vision and hearing impairments, osteoporosis, and chronic heart failure were also significantly more common among adults with ASD than controls. Rate differences between cases and controls were variable across race/ethnic groups, especially for diabetes and epilepsy. Of note, adults with ASD were significantly less likely to use alcohol (23% vs. 53%) or smoke (16% vs. 30%). Finally, the rate of cancer was similar between ASD cases and controls (2.7% vs. 2.6%). [emphasis added]

Conclusions: Adults with ASD have a significant burden of major psychiatric and medical conditions. Their underlying impairments in social communication and increased sensory sensitivities likely impede the delivery of preventive health care. Improved strategies for delivering the most appropriate and effective health care are needed for this growing population.

Yet Another Purported Risk Factor: Paternal Obesity

The number of purported risk factors for autism has become bewildering.  MedPage Today reports:

Paternal obesity was strongly associated with increased risk for several autism spectrum disorders in children, according to a population-based study.

Children of obese fathers had an increased risk for developing autistic disorder and Asperger disorder, and the risk grew with increasing body mass index (BMI), wrote Pål Surén, MD, MPH, of the Norwegian Institute of Public Health in Oslo, and colleagues, in the May issue of Pediatrics.
...
"We had thought that maternal obesity may somehow be related to autism, but this is the first time anyone has looked at paternal weight, and the findings suggest we may have gotten it wrong," commented Andrew Adesman, MD, chief of developmental and behavioral pediatrics at Steven & Alexandra Cohen Children's Medical Center of New York in Lake Success, N.Y.

Adesman, who was not involved in the current research, pointed out that it's not clear from either of the studies if obesity plays a causal role in autism. Even if future studies did demonstrate causality, the impact of parental obesity on autism spectrum disorders is likely to be small, he added.

"Most of the children with autism in this study were not born to obese fathers and most of the children born to obese fathers did not develop autism," he told MedPage Today. "The risk (for autistic disorder) increased from 15 per 10,000 cases (children with normal-weight dads) to 25 in 10,000 cases (children with obese dads), which is still very, very low."

Autism and Obesity

A new study linking autism and obesity is getting a great deal of media attention. CBS reports:

Autism is more likely to occur in children whose mothers were obese while pregnant, new research suggests.

The study, one of the first of its kind, involved about 1,000 California children, ages 2 to 5. Researchers affiliated with the UC Davis MIND Institute looked at their mothers' medical records and examined the association between obesity and autism. Women who were obese during pregnancy were about 67 percent more likely than normal-weight women to have autistic children, the study showed. Obese moms also faced double the risk of having children with other developmental delays.

Obesity isn't the only risk factor found for pregnant moms in the study. Researchers also looked at prevalence of gestational diabetes and found pregnant moms with diabetes had nearly 2 1/3 times the chance of having a child with developmental delays compared with healthy mothers. Although the proportion of diabetic mothers who had a child with autism was higher, the numbers did not reach statistical significance.

The study was published online in the April 9 issue of Pediatrics.