On March 28th, 2014, the Centers for Disease Control issued a press release detailing a concerning jump in the incidence of autism spectrum disorders. Among 8 year old children (and their families) interviewed in 1 of 11 ADDM (Autism and Developmental Disabilities Monitoring) national sites, the prevalence of autism had grown markedly. Still significantly more common among Caucasian boys (1 in 42) with a mixed gender and race incidence of 1 in 68, autism has reached epidemic proportions. Why the jump? Without question, some of this increase is secondary to more astute observation by both physicians and parents, as well as a broadening of attributes that lend themselves to this diagnosis. But these two factors are not the only issue affecting incidence – the number of children with social skill disruption and poor communicative abilities is actually increasing. We have all been privy to the tireless debate concerning vaccines. Could this be the culprit? Countless studies have failed to demonstrate a causal relationship between vaccines alone and the onset of autism. But does our environment in some way play a role? Is it secondary to the use of bisphenol A (BPAs), genetically modified organisms (GMOs), pesticides and artificial food ingredients? Could it be the density of heavy metals in our soil, the chlorofluorocarbons in our air, infection with a new supermutated virus or simply evolving baseline genetics? Clearly the question is not an easy one to answer, but I think we can feel confident in the assertion that autism has multifactorial roots.

A few recent studies indicate increasing incidence of autism in children of aging mothers, as well as aging fathers – even independent of his wife’s age. Generally speaking, genetic mutations occur with greater incidence among older parents. Secondarily, babies born to mothers with elevated inflammatory markers during pregnancy, either from marked illness such as the flu or from a pregnancy related disease – such as pregnancy induced hypertension suffer higher rates of autism spectrum disorders. There is even some very preliminary data regarding the use of ibuprofen in the latter part of the first trimester and through the second trimester of pregnancy to reduce inflammation in the mother during prenatal neurologic development. Of note, Ibuprofen should not be taken in the 3rd trimester when this medication can interfere with the closing of prenatal heart ducts as the baby transitions to extra uterine life. This, of course, is not a recommendation, but the concept shows some interesting promise. I still remember reading in medical school that a pregnant mom’s immune system is somewhat depressed during pregnancy so that she does not recognize her unborn baby as “foreign” and fight the progression of the pregnancy, but perhaps the immune system relaxes a bit to allow baseline reductions in inflammatory markers as well. ‘Elevated CRP (c-reactive protein) is a marker that the body is undergoing a response to inflammation from, for example, a viral or bacterial infection,’ said, Alan Brown, M.D., professor of clinical psychiatry and epidemiology at Columbia University. “The higher the level of CRP in the mother, the greater the risk of autism in the child.”

So, what can we do to help minimize the risk among our own children? Most importantly, future mothers should begin a prenatal vitamin with at least 800mcg of folic acid while trying to conceive. Expectant mothers that took folic acid daily during pregnancy had a 40% reduced risk of autism in their offspring. Folic acid before and during pregnancy has also been linked to reduced incidence of neural tube defects and additional genetic disorders in newborns. This is such a simple recommendation and has such an impressive impact! Even if you found out about your pregnancy a few weeks in, after a glass of sauvignon blanc and a relaxing soak in a Jacuzzi, a prenatal vitamin with ample folic acid will have a positive impact–several studies demonstrate the greatest benefit between 6 weeks and 6 months of pregnancy.

Future mothers should begin a prenatal vitamin with at least 800mcg of folic acid while trying to conceive.

Additionally, getting a preservative free flu vaccine when pregnant will help prevent an illness that will undoubtedly trigger an inflammatory cascade and the resultant fevers, chills, decreased appetite, and poor sleep that cumulatively have the potential to harm your baby. In fact, studies indicate that hospitalization for a viral infection, such as the flu, during the first trimester of pregnancy triples the odds of having an autistic child. Good contact precautions are important too when spending time with ill friends, family or in some cases, patients! Of course, it is important to live your life even when you are expecting, so if despite common sense precautions you get sick, so be it. We can only try to avoid illness, and sometimes despite our best efforts, we get sick anyway. The comforting news is usually all turns out well regardless! It is very easy to think in extremes, especially as a parent, but it is so important to remember that a single occurrence rarely portends the future.

A raw, organic, minimally processed diet rich in protein, fat, vitamins and minerals is also bound to help build healthy cells in the baby as well as support the immune system in mom. Minimize exposure to pesticides, artificial ingredients, BPAs, GMOs etc., especially until more data unfolds regarding the effects of such exposure.

There are of course, things we can’t control as moms – whether we are expecting a newborn or chasing a toddler. Autism rates are on the rise, and it is clearly not just because our methods of detection have improved. So pick up some prenatal vitamins- rich in folic acid, make sure your vaccines are up to date, eat a diet that will support your future child’s growth and development, and my hope is you will confer some protection to your little one from the very start… And if you become ill or find out late into your first trimester that you are pregnant, remember that the odds are that your little one will be ridiculously healthy. I have seen several kids undergo intense stress in utero, from maternal pneumonia to a primary maternal infection with fifths disease… These little ones are thriving, despite all the aforementioned data…