Does Maternal Vitamin D Affect Childhood ADHD?

Can ADHD Be Prevented?

vitamin dIf you are pregnant, or of childbearing age, should you be supplementing with vitamin D? Increasingly, the answer appears to be yes.

1) Based on blood 25-hydroxy vitamin D levels (considered the most accurate marker of vitamin D status):

    • 8-11% of pregnant women in the US are deficient in vitamin D (<30 nmol/L).
    • 25% of pregnant women have insufficient vitamin D status (30-49 nmol/L).

In short, that means around 1/3 of pregnant women in the US have insufficient or deficient levels of vitamin D. The effect of inadequate vitamin D during pregnancy is not just an academic question.

2) The Cochrane Collaboration (considered the gold standard for evidence-based medicine) has recently concluded that supplementation with vitamin D reduces the risk of significant complications during pregnancy.

3) Another recent study found that inadequate vitamin D status during pregnancy delayed several neurodevelopmental milestones in early childhood, including gross motor skills, fine motor skills, and social development.

If neurodevelopmental milestones are affected, what about ADHD? Here the evidence is not as clear. Some studies have concluded that vitamin D deficiency during pregnancy increases the risk of ADHD in the offspring. Other studies have concluded there is no effect of vitamin D deficiency on ADHD.

Why the discrepancy between studies?

  • Most of the previous studies have been small. Simply put, there were too few children in the study to make statistically reliable conclusions.
  • Most of the studies measured maternal 25-hydroxyvitamin D levels in the third trimester or in chord blood at birth. However, it is during early pregnancy that critical steps in the development of the nervous system take place.

Thus, there is a critical need for larger studies that measure maternal vitamin D status in the first trimester of pregnancy. This study (M Sucksdorff et al, Journal of the American Academy of Child & Adolescent Psychiatry, 2020, in press) was designed to fill that need.

How Was The Study Done?

Clinical StudyThis study compared 1,067 Finnish children born between 1998 and 1999 who were subsequently diagnosed with ADHD and 1,067 matched controls without ADHD. There were several reasons for choosing this experimental group.

  • Finland is among the northernmost European countries, so sun exposure during the winter is significantly less than for the United States and most other European countries. This time period also preceded the universal supplementation with vitamin D for pregnant women that was instituted in 2004.

Consequently, maternal 25-hydroxyvitamin D levels were significantly lower than in most other countries. This means that a significant percentage of pregnant women were deficient in vitamin D, something not seen in most other studies. For example:

    • 49% of pregnant women in Finland were deficient in vitamin D (25-hydoxyvitamin D <30 nmol/L) compared to 8-11% in the United States.
    • 33% of pregnant women in Finland had insufficient vitamin D status (25-hydroxyvitamin D 30-49.9 nmol/L) compared to 25% in the United States.
  • Finland, like many European countries, keeps detailed health records on its citizens. For example:
    • The Finnish Prenatal Study collected data, including maternal 25-hydroxyvitamin D levels during the first trimester), for all live births between 1991 and 2005.
    • The Care Register for Health Care recorded, among other things, all diagnoses of ADHD through 2011.

Thus, this study was ideally positioned to compare maternal 25-hydroxyvitamin D levels during the first trimester of pregnancy with a subsequent diagnosis of ADHD in the offspring. The long-term follow-up was important to this study because the average age of ADHD diagnosis was 7 years (range = 2-14 years).

Does Maternal Vitamin D Affect Childhood ADHD?

Child With ADHDThe answer to this question appears to be a clear, yes.

If you divide maternal vitamin D levels into quintiles:

  • Offspring of mothers in the lowest vitamin D quintile (25-hydroxyvitamin D of 7.5-21.9 nmol/L) were 53% more likely to develop ADHD than offspring of mothers in the highest vitamin D quintile (49.5-132.5 nmol/L).

When you divide maternal vitamin D levels by the standard designations of deficient (<30 nmol/L), insufficient (30-49.9 nmol/L), and sufficient (≥50 nmol/L):

  • Offspring of mothers who were deficient in vitamin D were 34% more likely to develop ADHD than children of mothers with sufficient vitamin D status.

The authors concluded: “This is the first population-based study to demonstrate an association between low maternal vitamin D during the first trimester of pregnancy and an elevated risk for ADHD diagnosis in offspring. If these findings are replicated, they may have public health implications for vitamin D supplementation and perhaps changing lifestyle behaviors during pregnancy to ensure optimal maternal vitamin D levels.”

Can ADHD Be Prevented?

Child Raising HandI realize that this is an emotionally charged title. If you have a child with ADHD, the last thing I want is for you to feel guilty about something you may not have done. So, let me start by acknowledging that there are genetic and environmental risk factors for ADHD that you cannot control. That means you could have done everything right during pregnancy and still have a child who develops ADHD.

Having said that, let’s examine things that can be done to reduce the risk of giving birth to a child who will develop ADHD, starting with vitamin D. There are two aspects of this study that are important to keep in mind.

#1: The increased risk of giving birth to a child who develops ADHD was only seen for women who were vitamin D deficient. While vitamin D deficiency is only found in 8-11% of pregnant mothers in the United States, that is an average number. It is more useful to ask who is most likely to be vitamin D deficient in this country. For example:

  • Fatty fish and vitamin D-fortified dairy products are the most important food sources of vitamin D. Fatty fish are not everyone’s favorite and may be too expensive for those on a tight budget. Many people are lactose intolerant or avoid milk for other reasons. If you are not eating these foods, you may not be getting enough vitamin D from your diet. This is particularly true for vegans.
  • If you have darker colored skin, you may have trouble making enough vitamin D from sunlight. If you are also lactose intolerant, you are in double trouble with respect to vitamin D sufficiency.
  • Obesity affects the distribution of vitamin D in the body. So, if you are overweight, you may have low 25-hydroxyvitamin D levels in your blood.
  • The vitamin D RDA for pregnant and lactating women is 600 IU, but many multivitamin and prenatal supplements only provide 400 IU. If you are pregnant or of childbearing age, it is a good idea to look for a multivitamin or prenatal supplement that provides at least 600 IU, especially if you are in one of the high risk groups listed above.
  • Some experts recommend 2,000 to 4,000 IU of supplemental vitamin D. I would not recommend exceeding that amount without discussing it with your health care provider first.
  • Finally, for reasons we do not understand, some people have a difficult time converting vitamin D to the active 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D in their bodies. If you are pregnant or of childbearing age, it is a good idea to have your blood 25-hydroxyvitamin D levels determined and discuss with your health care provider how much vitamin D you should be taking. Many people need more than 600 IU to reach vitamin D sufficiency status.

#2: Maternal vitamin D deficiency has a relatively small effect (34%) on the risk of the offspring developing ADHD. That means assuring adequate vitamin D status during pregnancy should be part of a holistic approach for reducing ADHD risk. Other factors to consider are:

  • Low maternal folate and omega-3 status.
  • Smoking, drug, and alcohol use.
  • Obesity.
  • Sodas and highly processed foods.

Alone, each of these factors has a small and uncertain influence on the risk of your child developing ADHD. Together, they may play a significant role in determining your child’s risk of developing ADHD.

In closing, there are three take-home lessons I want to leave you with:

1) The first is that there is no “magic bullet”. There is no single action you can take during pregnancy that will dramatically reduce your risk of giving birth to a child who will develop ADHD. Improving your vitamin D, folate, and omega-3 status; avoiding cigarettes, drugs, and alcohol; achieving a healthy weight; and eating a healthy diet are all part of a holistic approach for reducing the risk of your child developing ADHD.

2) The second is that we should not think of these actions solely in terms of reducing ADHD risk. Each of these actions will lead to a healthier pregnancy and a healthier child in many other ways.

3) Finally, if you have a child with ADHD and would like to reduce the symptoms without drugs, I recommend this article.

The Bottom Line

A recent study looked at the correlation between maternal vitamin D status during the first trimester of pregnancy and the risk of ADHD in the offspring. The study found:

  • Offspring of mothers who were deficient in vitamin D were 34% more likely to develop ADHD than children of mothers with sufficient vitamin D status.

The authors concluded: “This is the first population-based study to demonstrate an association between low maternal vitamin D during the first trimester of pregnancy and an elevated risk for ADHD diagnosis in offspring. If these findings are replicated, they may have public health implications for vitamin D supplementation and perhaps changing lifestyle behaviors during pregnancy to ensure optimal maternal vitamin D levels.”

In the article above I discuss what this study means for you and other factors that increase the risk of giving birth to a child who will develop ADHD.

For more details read the article above.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure, or prevent any disease.

 

Does Folic Acid During Pregnancy Reduce Autism Risk From Pesticide Exposure?

The Role Of Optimal Nutrition In Prenatal Health

Author: Dr. Stephen Chaney

autismThere is no question autism rates are skyrocketing. The prevalence of autism in young children has increased 2-fold since 2000, 4-fold since 1996, and as much as 13-fold since 1980. A large part of that increase is simply due to changes in the diagnostic criteria for autism, but there are probably biological and environmental factors involved as well.

The increase in autism has been blamed on vaccinations, cell phones, and GMO foods, but those theories have largely been debunked (I’m not sure anyone really believed that cell phone use by the parents could cause autism in their children).

Does folic acid during pregnancy reduce autism risk from pesticide exposure?

The recent claim that glyphosate exposure may cause autism has proven to be controversial, but that is just the “tip of the iceberg.”  Numerous recent studies have suggested that pesticide exposure during conception and pregnancy may increase the risk of autism in the children. This is at least a plausible hypothesis. Most pesticides are neurotoxins, and animal studies have shown that pesticide exposure during conception and pregnancy can affect neurological development in the offspring.

This is a “bad news – good news” situation. The bad news is we live in an increasingly polluted world and some exposure to pesticides is inevitable. We can reduce pesticide exposure in the food we eat by choosing organic, but even organically-grown produce contains some pesticides . Even worse, a recent study found 217 neurotoxic chemicals in the umbilical cord blood of newborn babies.

The good news is optimal nutrition during conception and pregnancy may reduce the risk of autism. In a previous study (R.J. Schmidt et al, Epidemiology, 22: 476-485, 2011 q), the authors showed that for mothers with a MTHFR gene defect, a prenatal supplement providing 400 ug of folic acid per day was associated with a 4.5-fold decreased risk of giving birth to a child with autism. That lead them to ask whether optimum folic acid status could reduce the effect of pesticides on autism risk.

[Note: I am not sharing this study with you because it is definitive. It is not. Further studies will be required to confirm these results. I am sharing it with you because, if true, it has some important implications that are not usually discussed in the scientific or popular literature.]

How Was The Study Designed?

folic acid during pregnancyThis study (R.J. Schmidt et al, Environmental Health Perspectives, doi: 10.1289/EHP604) is what is known as a case control study. The mothers in the study were part of the Childhood Autism Risks From Genetics and the Environment (CHARGE) study. The children in the study were clinically confirmed to have ASD (autism spectrum disorders). The investigators chose 296 families from the CHARGE group for whom maternal folic acid intake and pesticide exposures were known. They compared them to 220 controls that did not have ASD and were matched by age, ethnicity, and socioeconomic status.

They assessed household pesticide exposure (pet flea & tick products, indoor pesticides, and outdoor sprays or foggers) through telephone interviews. They also used telephone interviews to estimate total folic acid intake from multivitamins, prenatal vitamins and vitamin fortified foods. They assessed agricultural pesticide exposure based on proximity to areas of heavy agricultural pesticide use.

They considered the autism risk of women who were taking 800 ug of folic acid and had no known exposure to pesticides as the baseline. Anything below 800 ug was consider low folic acid intake. Basically, they were looking at the effects of low folic acid intake and pesticide exposure on autism risk.

 

Does Folic Acid During Pregnancy Reduce Autism Risk From Pesticide Exposure?

folic acid during pregnancy during pesticide exposureFor women with low folic acid intake during conception and early pregnancy, pesticide exposure significantly increased autism risk. The breakdown was as follows;

  • Exposure to any indoor pesticides increased autism risk 2.5-fold.
  • Exposure to pet flea & tick pesticides increased autism risk 3.9-fold.
  • Exposure to indoor pesticide sprays & foggers  increased autism risk 2.6-fold.
  • Exposure to outdoor pesticide sprays & foggers increased autism risk 4.1-fold
  • Exposure to agricultural pesticides increased autism risk 2.2-fold.

In contrast, high (800 ug) intake of  folic acid during pregnancy (early) and conception significantly decreased the effect of pesticide exposure on autism risk. The breakdown was as follows:

  • 27% decrease in autism risk due to exposure to any indoor pesticides.
  • 59% decrease in autism risk due to pet flea & tick pesticide exposure.
  • 32% decrease in autism risk due to indoor pesticide sprays & foggers.
  • 56% decrease in autism risk due to outdoor pesticide sprays & foggers.
  • 50% decrease in autism risk due to agricultural pesticide exposure.

In short, this study suggests that pesticide exposure during pregnancy increases autism risk and 800 ug of folic acid during conception and early pregnancy substantially decreases the effect of pesticide exposure on autism risk.

What Does This Study Mean For You?

pesticide exposureIf confirmed by subsequent research, this study has several significant implications that deserve serious consideration.

#1:Pesticide exposure is ubiquitous. Nobody wants bugs in their house or on their garden plants, so we spray pesticides everywhere without giving it a second thought. We don’t want to be bothered by mosquitoes so we use foggers on our outdoor areas and spray bug repellents on ourselves when we go outdoors. We want the perfect lawn so we hire someone to spray gallons of pesticides and herbicides on the lawn where we and our children will play. We have pesticides on our food and in our water. If we live in agricultural areas, we breath pesticides. That’s how we end up with 287 environmental toxins (217 of which are neurotoxins) in the umbilical cord blood of newborn babies.

#2: Pesticide exposure is not innocuous. This study suggests pesticide exposure during pregnancy increases autism risk. Other studies suggest pesticide exposure increases the risk of ADHD, birth defects, cancer and much more. None of these studies is definitive by itself. The problem is that most pesticide exposure is at relatively low levels. In addition, nobody is pesticide free so it is difficult to find a good control population. It would require very large population studies to show conclusive effects, and those studies would be extremely expensive. However, when you see study after study suggesting that pesticide exposure may be harmful to our health, it may be time to take notice and ask whether all this pesticide use is essential.

#3: Supplementation may help protect us from environmental toxins. This study suggests that folic acid during pregnancy helps protect against the autism risk from pesticide exposure. Other studies suggest supplementation helps protect against the bad effects of other environmental toxins. We talk about the need of supplementation to fill the nutritional gaps of our bad diets. We talk about how supplementation can help meet the increased needs associated with disease, biological stress and genetic defects. However, we seldom talk about the need for supplementation to help protect us from environmental toxins in our increasingly polluted world.

#4: Flea & tick pesticides for your pets are among the worst offenders. If you are a woman who is pregnant or of childbearing age, have your husband or veterinarian handle the flea & tick medicine. You don’t want to be touching the stuff.

#5: Once again, folic acid was sufficient to do the job, even in women with MTHFR deficiency.

 

The Bottom Line

 

A recent study suggests that pesticide exposure during pregnancy increases autism risk, and that supplementation with 800 ug of folic acid during conception and early pregnancy substantially decreases the effect of pesticide exposure on autism risk.

There are several important implications of this research.

  • Pesticide exposure is ubiquitous. That’s how we end up with 287 environmental toxins (217 of which are neurotoxins) in the umbilical cord blood of newborn babies.
  • Pesticide exposure is not innocuous. This study suggests that pesticide exposure during pregnancy significantly increases autism risk in newborns. Other studies suggest pesticide exposure increases the risk of ADHD, birth defects, cancer, and much more. Perhaps it is time to seriously consider decreasing pesticide usage.
  • Flea & tick medicines for your pets are among the worst offenders. If you are a woman who is pregnant or of childbearing age, have your husband or veterinarian handle the flea & tick medicine. You don’t want to be touching the stuff.
  • Supplementation can help protect us from environmental toxins. This study suggests folic acid can help protect pregnant women against the autism risk from pesticide exposure during pregnancy. Other studies suggest supplementation helps protect against the bad effects of other environmental toxins. We don’t give enough consideration to the need for supplementation to help protect us from environmental toxins in our increasingly polluted world.
  • Once again, folic acid was sufficient to do the job, even in women with MTHFR deficiency.

 

For more details, read the article above.

 

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

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