The LA Times article yesterday quoted an epidemiologist Rebecca Schmidt of the UC Davis MIND Institute saying that women who reported that they had not taken prenatal vitamins immediately before and during a pregnancy were twice as likely to have a child with autism. The researchers asked 700 women retrospectively if they were taking vitamins – a strategy that has been shown to be less than reliable. (Do YOU remember what you did six months or five years ago?) These women had children who were 2 to 5 years old and were diagnosed with autism. An interesting twist to the research was an attempt to stratify the women and screen them for two gene variants that are affected by taking supplemental folic acid and that have been linked to autism in prior research. The two gene variants were MTHFR and COMT. We’ve known that MTHFR (methylene tetrahydrofolate reductase) is a key enzyme in folic acid metabolism and that if a woman has a variant in this gene that she is at increased risk for giving birth to a child with neural tube defects. We also know that folic acid, vitamin B6 and vitamin B12 supplementation can “over ride” this gene uniqueness. COMT (catechol-o-methyl transferase) is a key enzyme involved in the metabolism of compounds such as catecholamines (epinephrine and norepinephrine), estrogens, and other pharmaceutical drugs and environmental toxins. B vitamins also may help negate the effect of this gene variant, but the situation is more complex than just adding vitamins.

So the LA Times article was helpful and reiterated what we’ve known for many years: prior to conception women (and probably also men) should supplement their diet with folic acid and other B vitamins. But claiming that autism rates were up to seven times higher in women with one of the gene variants was perhaps a little bit of a leap. (and attention-grabbing…because of course it got MY attention, right?!)

About the same time that the article was published I read an article in the Atlantic Monthly by David Freeman which chronicled the work of Dr. John Ioannidis. He is known for his mathematical models that show that most of today’s medical research is questionable. Quoting Freeman:

“In the paper, Ioannidis laid out a detailed mathematical proof that, assuming modest levels of researcher bias, typically imperfect research techniques, and the well-known tendency to focus on exciting rather than highly plausible theories, researchers will come up with wrong findings most of the time….His model predicted, in different fields of medical research, rates of wrongness roughly corresponding to the observed rates at which findings were later convincingly refuted: 80 percent of non-randomized studies (by far the most common type) turn out to be wrong, as do 25% of supposedly gold-standard randomized trials, and as much as 10% of large randomized trials. The article spelled out his belief that researchers were frequently manipulating data analyses, chasing career-advancing findings rather than good science, and even using th peer-review process to suppress opposing views.”

So, the upshot? I recommend prenatal vitamins prior to conception. I recommend a pre-conception visit to review health history, medications, supplements and screen a pap smear, a rubella titer and possibly genetic counseling depending on the prospective parents’ ages, ethnic backgrounds and family histories. A pre-conception visit is an excellent time to look at stress-management tools, work schedule adjustments, and possibly bring up parenting styles and beliefs for consideration. A thoughtful, planned pregnancy is ideal. Since upwards of two thirds of pregnancies are unplanned, however, I encourage daily vitamin use for all people who are sexually active.