Step 2: Self care prenatally; why? what about everyone else?

I mentioned earlier in Step 2 that many of the action steps would be similar for people of all ages but that fetal development is at most critical risk. So starting with fetal health is a good place to start and it may be the best place to promote optimal development for a child in the first place rather than having to discover and manage a chronic disease  or congenital* condition after it has been diagnosed. (*A congenital condition is one that is present at birth however while many are screened for many other conditions may not be identified or diagnosed quickly.)

Adequate nutrition prenatally may be helping protect both the infant from risks of neurological conditions or birth defects, and the mother from risk of autoimmune disease from developing, due to the role vitamin D plays in preventing white blood cells from being overly allergic to foreign material — which would include maternal or infant DNA, some of which has been found to be able to cross the placenta from mother to child or from child to mother. The mother’s level of available vitamin D would also have to provide vitamin D for the fetus. Vitamin D may be important for protecting the fetal brain development and protecting against changes that might lead to the child developing autism or other neurological conditions later in life.

Learning more about what causes autism and autoimmune disorder in the infant and mother can also help by giving clues about what might help prevent the conditions from developing for other people. What helps them might be helpful for the rest of us too. Alzheimer’s disease seems to have some similarities to autoimmune disease and autism. A gene defect has been identified and studied in mice which was found to increase risk of autism like symptoms in younger male mice and risk of Alzheimer’s dementia like symptoms in older female mice with the defect. Better understanding of the protein encoded by the gene and the protein’s role within the brain may help lead to more effective treatments or preventative guidance.

Brain scans have shown that changes occur prenatally during fetal development that can be observed in MRI scans as early as six to twelve months old.

The risk for autism spectrum disorder to occur in later childhood may be developing in the newly conceived fetus as early as the first few days and weeks, when the first few cells may have formed, and the zygote needs to implant somewhere along the wall of the mother’s uterus — before the woman  even knows that she has conceived. So it is tricky to try to protect against problems that occur before you know the event has even happened — but you can plan ahead and prepare as if the chance occurrence might happen, even if it is unlikely.

Taking prenatal vitamins with folic acid during childbearing years is recommended to help reduce risk of spina bifida and other neural tube defects and it may also help reduce risk of autism. Preventing all unplanned pregnancies is not possible but taking vitamins and trying to maintain health might be possible for many people if they were motivated. Having birth control and using it consistently, or saying no to unprotected sex, especially if alcohol was used, might also help prevent autism and other risks such as fetal alcohol syndrome but motivation and planning ahead are necessary. Some might need more help than others with saying no, especially if alcohol is involved, while others might need help getting or reliably using birth control or remembering to take a vitamin every day.

Recent research has found a significant association between vitamin D deficiency at a midpoint during gestation and autism developing later in the child. The association was significant for the prenatal level of vitamin D but not for the cord sample level, suggesting that changes that later lead to autism risk were in part due to developmental changes that occurred at some point during the early or midstages of pregnancy. Gestational vitamin D deficiency and autism spectrum disorder  (A.A.E. Vinkhuyzen et al., BJPsych Open. 2017 Mar; 3(2): 85–90.)

Here’s some motivation to help encourage working towards more planned pregnancies: autism has been diagnosed during infancy, before symptoms have occurred.

Early research suggests that it is possible to diagnose autism risk in infants before the symptoms are obvious.

There are now at least two different ways medical researchers have been able to diagnose which infants will later go on to develop autism as children – strongly suggesting that at least for those children something did occur prenatally, which had affected the infant enough for a diagnosis to be able to be made in advance of the symptoms in later childhood.

Umbilical cord blood samples of infants that developed normally were compared with the samples of infants that went on to develop autism for many (75) different types of lab tests. Of those many values fifteen were found to be consistently different between the group of infants that developed typically and those that had later developed autism symptoms. The researcher recommended to save costs by screening all infants with the five lab tests that were most consistently different and then to rule out false positives then screen the infants that didn’t have typical lab results for the next most consistent five lab tests, and then screen with the remaining five for the most accurate predictive diagnosis – the infant wouldn’t have autism but might be in a high risk group that would most benefit from making the dietary and lifestyle changes discussed in Step 2.

MRI brain scans have been used successfully to diagnose which scans were from people with autism disorder and which were from people without autism. But these were older individuals who already had developed autism. People with autism seem to have consistently different ways of thinking about their actions and interactions with others when compared to people without autism.

“There was an area associated with the representation of self that did not activate in people with autism,” Just says. “When they thought about hugging or adoring or persuading or hating, they thought about it like somebody watching a play or reading a dictionary definition. They didn’t think of it as it applied to them.” This suggests that in autism, the representation of the self is altered, which researchers have known for many years, Just says. “But this is the first time that anybody’s used that to diagnose autism looking at brain activation.”

– Lead study author Marcel Just, PhD, professor of psychology and director of the Center for Cognitive Brain Imaging at Carnegie Mellon University,

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More recently younger infants around six months old were scanned in MRI units (which having had the procedure done once, let me assure you as a mother I would hesitate to have my six month old have to undergo an MRI – aka the claustrophobia inducing loud noise machine – but these were infants considered already at higher risk for developing autism because they had an older sibling who already had a diagnosis of autism and worrying about autism risk might be a bigger worry than noisy machines.) and identifiable differences in brain structure was found in some of the infants who later went on to develop autism.

Again suggesting, but in a more traumatizing way then umbilical cord blood samples, that changes are occurring prenatally that leave infants susceptible to developing autism symptoms later in life – at least in some of the patients with autism there may be different types or different assortments of precursors leading to slightly different types.

Other information gathered from the MRI work being done with infants and autism found differences in cerebrospinal fluid. There was more present in the infants that went on later to develop autism and larger amounts was associated with more severe autism.

Cerebrospinal fluid is involved in very early fetal brain development – and it can require adequate sulfate:

  • Embryonic cerebrospinal fluid in brain development: neural progenitor control, Angel Gato, et. al., Croat Med J. 2014 Aug; 55(4): 299–305 Excerpt:Two different mechanisms of the CSF origin have been proposed (17): the first is apical secretion of specific macromolecules by neuroepithelial cells into the cavity. This mechanism is mainly supported by the studies of Gato et al (1820), which show an active apical secretion of chondroitin sulfate proteoglycan. The second is an active intercellular or intracellular transport of molecules, such as FGF2 (21) and other types of proteins (17,22) or ions (23) across the neuroepithelium from the basal to apical side. Some studies suggest that there are specific areas where brain neuroepithelial transport takes place, which is similar to a primitive choroid plexus (17).

    On the basis of these data, we can conclude that embryonic CSF can be a means of inner communication between neuroepithelial precursor cells, in which some populations are involved in the creation of a complex signaling fluid, while other answer these signals.”

Sulfate was mentioned in 2E2d. It is made available in the skin with adequate sunshine or can be absorbed through the skin from Epsom salt baths or footsoaks. Sulfate is important in enzymes and for complex molecules involved in cell membrane stabilization and transport and communication on cell surfaces. A deficiency in sulfate during pregnancy might be affecting the fetal cebrospinal fluid – but more research would be needed.

Biomarker blood tests or use of MRI scans for use in the diagnosis of autism is still in the early phases of research rather than being readily available to doctors and patients. Unclear diagnosis makes getting help from insurance or governments more difficult.

The diagnosis of autism disorder was only recognized in Russia around 2001 according to an article that describes some of the difficulties facing families and patients there, who have symptoms of a disease or disorder that is not well understood. An article from 2015 suggests that the diagnosis and acceptance of patients with autism in Russia has made some progress but that it continues to be limited.

Identifying children early and providing special behavioral education guidance can help reduce severity of symptoms.

Oxidative stress is involved and providing ways to reduce it may help prevent autism from developing in susceptible children. A call for more research into the prenatal role in developing risk for autism is included in the book Autism:  Oxidative Stress, Inflammation, and Immune Abnormalities. (page 358, 2009)

So babies are important because that is when the risk for more severe autism might be identified and prevented before it becomes severe – and learning how they can be helped may help lead to more help for the rest of us too.

Step 2 will be referred to in later steps focused on issues more specific to infancy, childhood, teens, or adults, and for the environmental issues affecting home, work, and recreation.

At a global level unsafe air or water or other environmental conditions play a large role in the risk of chronic disease and birth defects. Providing clean water and sanitation and improving air quality can greatly improve health and quality of life.  Reducing the number of people living without access to clean water by fifty percent was a goal of the Millennium Development Goals (MDG-7) , mentioned in a 2006 report (page 15) by the World Health Organization, Preventing Disease through Healthy Environments. Excerpt:

This report confirms that approximately one-quarter of the global disease burden, and more than one-third of the burden among children, is due to modifiable environmental factors. . . . Heading that list are diarrhoea, lower respiratory infections, various forms of unintentional injuries, and malaria. This ‘environmentally-mediated’ disease burden is much higher in the developing world than in developed countries – although in the case of certain non-communicable diseases, such as cardiovascular diseases and cancers, the per capita disease burden is larger in developed countries.”

Environmental pollution can increase health risks for everyone in the area but may place people in younger and older age groups and those already chronically ill at greater risk. Improving the environment would help everyone in the area but might be more critically life saving for those more at risk.

Promoting health and preventing chronic diseases from developing can involve first identifying which personal lifestyle habits help promote health or prevent disease and which habits might be promoting disease — and even more specifically, for which types of people and how can we identify who those specific groups of people are. Not all health strategies help all groups of people equally so individualized guidance and lab tests or other ways to assess the effectiveness of a treatment can be important for some types of health recommendations or for people in higher risk groups (the young, the elderly, pregnant and breastfeeding women, and those with a chronic illness).

Improving air and water quality can also help reduce health care costs to individuals and businesses and hidden costs to business due to reduced productivity from workers being home ill or home taking care of sick family members instead of at work.

Health promotion can involve making changes at the local, state or national level as air and water quality can be affected by regional policies or other disruptions of government stability or services ( such as war or rebel groups or austerity style budget cuts).

The World Health Organization defines health promotion as: “The process of enabling people to increase control over, and to improve, their health. It moves beyond a focus on individual behavior towards a wide range of social and environmental interventions.”   – site defines disease prevention as:

disease prevention. activities designed to protect patients or other members of the public from actual or potential health threats and their harmful consequences.”

To prevent – to protect from actual or potential threats and their consequences.

We can’t be sure that preventative actions will protect against potential threats but we can’t be sure that they won’t help, so why not try?

An additional goal is to summarize the action steps into a condensed list including all of the the nutrients, food additives or chemicals, or other lifestyle activities that were mentioned in the action steps; and to expand the list to include whether the substance or activity might be helpful or harmful, or whether its risk would depend in some way on the type of person using it or the amount used; and where to find the nutrient or how to avoid the chemical or whether and how to avoid the lifestyle activity or modify it to increase safety or reduce risk of harm;

— simplified: an additional goal is to take out the clearly complicated ‘why,’ might something be linked to increased risk for autism, and leave a condensed list of ideas for ‘what’ to do, expanded to include ideas for ‘how’ to do it.

A checklist can help keep track of what has been tried and track progress along the way towards changing habits. Creating new habits and monitoring how they help can also help provide motivation to continue the new actions or to not repeat old the habits as often — if you notice that you’re feeling and looking better with the new habits then why repeat the old? and if you do repeat the old, then pay attention and remember how the old feels again — is it better? really? or might the new habits have left you feeling more comfortable or more energetic and they really are worth the effort?

Disclaimer: Opinions are my own and the information is provided for educational purposes within the guidelines of fair use. While I am a Registered Dietitian this information is not intended to provide individual health guidance. Please see a health professional for individual health care purposes.

Part of a series, continued from: