Study claims no link between autism and induced labor

A study revealed that there is no link between autism and induced labor.

There is no connection between inducing labor in childbirth and autism, according to a new statement released Monday by the American College of Obstetricians and Gynecologists.

Existing guidelines on when and how labor should be induced or accelerated should not be changed, because limiting labor inductions could have negative effects on the health of women and their babies, ACOG's committee on obstetric practice recommended in a "committee opinion."

Although some studies have suggested there may be a link between autism and the use of oxytocin to induce or speed up labor, this research has significant limitations, according to an ACOG news release. The studies were small, inconsistent and retrospective, the opinion said, and limited comparison groups meant certain factors might not have been accounted for.

The committee concluded there is no evidence to prove that labor induction causes autism.

The group also cautioned that any reduction in labor induction would "almost certainly" have a negative effect on patient care, and likely result in more cesarean deliveries.

"In obstetric practice, labor induction and augmentation play an essential role in protecting the health of some mothers and in promoting safe delivery of many babies," Dr. Jeffrey Ecker, committee chair, said in the news release.

"When compared with these benefits, the research we reviewed in assembling this committee opinion, relative to the utilization of oxytocin, had clear limitations," Ecker said. "Because of this, these studies should not impact how obstetricians already safely and effectively use labor induction and augmentation when caring for their patients."

The committee's opinion was endorsed by the Society for Maternal-Fetal Medicine. The findings were published in the May issue of Obstetrics & Gynecology.

Read more here

Increase in autism diagnosis rates since 2000

The CDC has found a steady increase in autism diagnosis rates since 2000. Reasons for this are unknown, but may be due to increased awareness.

Autism rates in children have continued their steady rise, surging 30 percent in two years, according to the latest data released Thursday by the Centers for Disease Control and Prevention. While 1 in 88 children were estimated to have autism in 2008, public health officials now estimate that 1 in 68 children are on the autism spectrum.

Those statistics are based on the 2010 medical records of 8-year-olds living in 11 communities throughout the United States that are part of the CDC’s autism surveillance network. When the CDC started its surveillance of these communities back in 2000, the incidence of autism was 1 in 150 children.

CDC officials couldn’t offer specific reasons for the rise beyond increased awareness of the condition among doctors, teachers, and parents. “It may be that we’re getting better at identifying autism,” said Coleen Boyle, director of the CDC’s National Center on Birth Defects and Developmental Disabilities, during a press briefing. “We do feel like some of this has to do with how children are identified, diagnosed, and served in their communities.”

Autism advocacy groups noted that the increasing prevalence underscores the need for research funding to identify the causes of autism. “To be perfectly frank, it’s an incomplete picture right now,” said Robert Ring, chief science officer at Autism Speaks, a research advocacy organization in New York City. “All the pieces of the puzzle aren’t in place.”

Certain trends have remained constant during the decade that the CDC has been collecting data. Autism remains five times more common in boys — affecting 1 in 42 compared with 1 in 189 girls — and white children are more likely to be diagnosed than black or Hispanic children, though the prevalence in those minority groups has risen at a faster rate than for whites.

About half of children with autism in 2010 had average or above-average intelligence, compared with a third in 2002.

“We now recognize that autism is a spectrum,” said Marshalyn Yeargin-Allsopp, chief of the CDC’s developmental disabilities branch. “Our understanding has evolved to the point that we understand that there are children with higher IQs who may not have been receiving services in the past.”

The CDC provided grants to 11 states across the country — including Arizona, Arkansas, Maryland, and Wisconsin — based on their ability to survey medical and school records for pediatric autism diagnoses. Massachusetts is not one of the sites providing data to the federal government.

Autism rates varied widely among the 11 areas under CDC surveillance. In Alabama, only 1 in 175 children had autism in 2010 compared with 1 in 45 children in New Jersey.

That difference could reflect varying access to expensive autism assessments and therapies among states. New Jersey mandated in 2010 that insurance companies must cover $36,000 per year in behavioral programs and other autism therapies for any person under age 21 who is diagnosed with the disorder. Alabama didn’t pass a coverage mandate until 2012. A Massachusetts coverage law took effect in 2011, and more than 30 other states instituted such laws as well.

Some children with behavioral or intellectual disabilities other than autism may receive the diagnosis from their doctors in order to qualify them for coverage for treatments that could benefit them too, said Dr. Sarah Spence, codirector of Boston Children Hospital’s Autism Spectrum Center. “Kids may get labeled with autism disorder because that’s the best way for them to get services, but I don’t think this overdiagnosis is a huge piece of the rising incidence.”

More likely, doctors have become more attuned to early signs of autism in toddlers and preschoolers, such as failure to make eye contact, smile, or express emotional attachments to their caregivers. The American Academy of Pediatrics recommends that health care providers conduct autism screening tests at every well-child visit.

“Doctors are getting better at doing these screenings,” Spence said, “to the point where every once in a while, I can happily tell parents that their child’s language delay isn’t autism.”

Despite this increased awareness, the average age at which a child is diagnosed hasn’t budged much; most children aren’t diagnosed until after 4 years of age, according to the CDC, two years after signs of the disorder usually start to appear.

“Research suggests that the earlier we intervene with treatment, the greater the probability that children will realize their full potential,” Ring said.

In an effort to get children diagnosed earlier, the US Department of Health and Human Services revealed an educational campaign on Thursday to make parents, teachers, and health care providers even more aware of early autism signs. Parents are advised to look for certain expected milestones in their child’s development, such as developing a fear of strangers, responding to other people’s emotions, and looking in the mirror by age 6 to 9 months.

One problem, however, that still remains unaddressed is the lack of behavioral specialists to assess and treat the growing population of children displaying signs of autism.

“The wait lists in Boston for assessment and treatment are too long,” Spence said, “and that’s unacceptable because every month counts when it comes to starting therapy.”

Read more here

Study: No link found between autism and celiac disease

A study claims there is no link between autism and celiac disease.

There's no link between celiac disease and autism spectrum disorders, a nationwide study from Sweden says.

People who were diagnosed with an autism spectrum disorder (ASD) in the study were no more likely to be diagnosed with celiac disease than people without an ASD.

Dr. Jonas Ludvigsson, the study's lead author, said the finding offers one less thing to worry about for people with either celiac or ASDs.

"To them, this is good news," Ludvigsson, of Sweden's Karolinska Institute, said.

Some researchers have reported on single cases of people who were diagnosed with an ASD and who were then diagnosed with celiac disease.

In celiac disease, which is estimated to affect about one percent of Americans, an individual's own immune system attacks the small intestines if they eat gluten, a protein in wheat and certain other grains.

Other studies have found that switching those people to gluten-free diets appeared to also reduce ASD symptoms, but larger trials have not shown any link between the two conditions.

For the new study Ludvigsson and his colleagues connected several Swedish databases to compare the celiac disease diagnoses among people with ASDs to a group of people without the developmental disorders.

The researchers had information on more than 250,000 people and they found no difference in the rate of ASD diagnoses among people with celiac disease compared to those without the condition.

About 44 people per 100,000 were diagnosed with an ASD before they were diagnosed with celiac disease. That compared to about 48 people per 100,000 who were diagnosed with an ASD but not with celiac disease.

There was, however, a link between ASDs and a positive blood test for celiac disease, which alone is not enough to diagnose someone with the condition. A celiac disease diagnosis requires both a positive blood test and evidence of damage to the small intestine.

"It's very interesting in my mind, because it points to some relationship to gluten that's separate from celiac disease," Dr. Peter Green, professor of medicine and director of the Celiac Disease Center at Columbia University Medical Center and a gastroenterologist at NewYork-Presbyterian/Columbia.

But Ludvigsson cautioned that the link between ASDs and a positive celiac blood test is based on a small number of cases. There could be a real relationship between the two or it could be a result of doctors overtesting people with ASDs, he said.

"I want to underline that the positive association we found in this small group could be by chance," Ludvigsson said.

The study also does not shed any light on whether a gluten-free diet improves ASD symptoms, he added.

"I think the next step would be for someone to carry out a well-performed study on a gluten-free diet in autism," Ludvigsson said. "There are several such studies, but my understanding is that they haven't been large enough in size."

Green, who was not involved in the new report, agreed that people can't draw any conclusions on gluten-free diets for autism.

"This (study) provides some evidence that there may be a role, but it may also help to find those who would possibly benefit from this therapy," he said.

Ludvigsson, who published his findings in JAMA Psychiatry, said it's also important to examine possible relationships between celiac disease and other "neurocognitive" disorders.

"Our study is definitive when it comes to refuting an association between celiac disease and autism, however, we can't rule out that autism is related to other intestinal conditions that do not fulfill the traditional criteria of celiac disease," he added.

Enzymes may be why autism develops

A study from the NIH shows that a group of enzymes may be the cause that autism develops.

A group of enzymes in the brain appears to be key to the activity of many genes linked to autism, a new study reveals.

Experts hope the findings will shed light on the causes of autism, and possibly lead to new treatments.

The study results, published online Aug. 28 in the journal Nature, hint that if disruptions in enzymes called topoisomerases occur during brain development, they might contribute to the development of autism spectrum disorders.

The enzymes are found throughout the body, and their main job is to "untangle the knots" in cells' DNA so the cells can function and reproduce themselves normally, explained senior researcher Mark Zylka, an associate professor of cell biology at the University of North Carolina at Chapel Hill.

Topoisomerases have been well studied for their role in helping tumor cells to spread, and drugs that inhibit the enzymes are already used to treat certain cancers.

There have also been hints, though, that topoisomerases might contribute to autism. Last year, researchers reported that some people with autism spectrum disorders have mutations in these enzymes.

"But we've known little about how they work in the brain," said Zylka.

In lab experiments with mouse and human brain cells, Zylka's team found that a topoisomerase-inhibiting drug reduced the activity of 49 genes that past studies have linked to autism. That points to the importance of topoisomerases in the normal expression of those genes.

"A single drug down-regulated all of those genes," Zylka said.

That does not mean, however, that topoisomerase inhibitors should be tested for treating autism. If anything, Zylka explained, you would want a drug that enhances the enzymes' actions.

But now researchers can look for compounds that do just that.

What's more, the findings point to a biological process that ties together dozens of different genes that are suspected of being involved in autism. "Well over 300 (autism-linked) genes have been identified now," Zylka said. "That list looks daunting, but the goal is to figure out how all these genes are connected," he said.

"It can be overwhelming when you look at the list of genes," agreed Andy Shih, senior vice president for scientific affairs for the advocacy group Autism Speaks.

But if you can zero in on the "biological pathways" linking those genes, "it all starts to make sense," said Shih, who was not involved in the study.

In the United States, it's estimated that at least one in every 88 children has an autism spectrum disorder, with the severity ranging widely from child to child. Some kids have little or no ability to speak, and focus obsessively on just a few interests; other kids speak and have normal to above-normal intelligence, but may have problems socializing and communicating more subtly -- for example, trouble using and "reading" gestures, body language and facial expressions.

No one knows what causes autism spectrum disorders, but experts believe that it's a complex mix of genetic vulnerability and environmental exposures -- possibly chemicals or microbes.

Shih pointed to an "interesting" fact about topoisomerases: Their activity is believed to be influenced by environment, including compounds in food and in the physical world. So, he said, studying the enzymes might help researchers pinpoint some of the environmental factors that contribute to autism spectrum disorders.

"We've been talking for a long time about the interaction between genes and environment in autism," Shih said. Topoisomerases could offer a way for scientists to begin to connect the dots.

Zylka agreed, and said his team is searching for environmental compounds that inhibit topoisomerases -- and may, therefore, be important for pregnant women or young children to avoid.

There is still, however, a long way to go in fully understanding the underpinnings of autism spectrum disorders. "We've just scratched the surface of what's going wrong in the brain" in autism, Zylka said.

Read more here