For the past few decades, autism has been one of the scariest mysteries of parenting, with debate swirling around its definition, how rapidly the epidemic is growing, and most urgently, what causes it. That's why we were surprised to read a claim this weekend by science writer Moises Velasquez-Manoff in the opinion section of The New York Times that scientists have figured it out: In at least a third of cases, autism is an auto-immune disorder that starts in the womb.
"The mother's attempt to repel invaders - her inflammatory response - seems at fault," the story says. A range of maternal issues from disorders like celiac disease, asthma and arthritis to getting sick during pregnancy in the most common ways--flu, urinary tract infections--have been shown to be significant risk factors for autism.
The story is a science-writer's synthesis (informed by a wide and reputable body of science) but has far-reaching implications for all pregnant women. Most surprisingly, it includes a twist on the autism-and-vaccines story, which is that the mother being vaccinated, even for common things like the flu, could be a risk factor for autism.
Current CDC guidelines and most obstetricians recommend routine vaccination during pregnancy.
Yahoo! Shine talked to a variety of experts and scientists whose research was quoted in the Times story, and found that the takeaways for pregnant women seem to be twofold. The first is that women with conditions like celiac disease, asthma, arthritis, metabolic syndrome or other auto-immune disorders should be aware that they are at a higher risk for having an autistic child.
The second is that all women may want to take sickness and infection during pregnancy more seriously, as a safety precaution.
"Everyone gets sick when they're pregnant and they don't all have autistic outcomes," Dr. Judy Van De Water told Yahoo! Shine. Dr. Van De Water is an immunologist who studies the immunobiology of autism in children at the MIND Institute at University of California, Davis. However, she says, "If you are exposed to something [while you are pregnant] and you respond very strongly to it, that could change factors that come from the immune system that affect neuro-development."
"Not every vaccination or flu episode is going to result in an autistic outcome," says Dr. Paul Patterson, a professor of biological science at CalTech whose research was also quoted in the Times story. "The factors involved are probably the genetics of the woman or the genetics of the fetus. Another factor would be the severity of the infection or the severity of the mother's response. The timing of the infection (first, second or third trimester). Not every infection results in an autistic outcome! One doesn't have to be scared to death, but it is a risk factor."
Dr Patterson's book Infectious Behavior: Brain-Immune Connections in Autism, Schizophrenia and Depression and his blog go into more detail about his thinking on autism, inflammation and what women can do. He told Yahoo! Shine that his research has shown in animals that "activating the mother's immune system artificially has the same effect on the offspring as the actual flu infection," a finding which implies questions about the safety of vaccination during pregnancy. "Getting a flu shot is controversial." Dr. Van De Water confirms.
Dr Van De Water recommends that women get their flu shot before they become pregnant. Dr Patterson suggests that women who decide not to get a flu shot while pregnant take "common-sense preventative measures that everyone already knows about but we don't do." These include: "Washing your hands constantly, especially when you have been out in public like going to the grocery store or putting gas in the car. Using anti-bacterial wipes on your hands. Avoiding people who are sick, like friends and relatives. Not eating raw meat, or don't change the cat litter."
As of yet, doctors do not have a universal screening method to predict which women are at risk to have autistic outcomes if they get sick during pregnancy. However, about 15 percent of mothers with autistic children have a particular type of auto-antibodies in their blood. This type of auto-antibodies, which are specific to fetal brain proteins, guarantee that the child will be an autistic, Dr Van De Water says, "100 percent of the time." A test for those antibodies, for widespread usage, is under development.
Though pregnant women want to take every precaution not to get sick, ironically, Moises Velasquez-Manoff's argument locates the source of the modern increase in auto-immune disorders to people not getting sick often enough. It's what's known as "the hygiene theory," which posits that the human immune system evolved to cope with the filthy and disease-ridden conditions of a previous era. Without microbes and parasites as a foil, it is more likely to function improperly, causing all kinds of health consequences including autism.
Correction: A previous version of this article misstated Dr Van De Water's research on auto-antibodies and autism. The auto-antibodies that result in an autistic outcome for children are of a specific type associated with fetal brain protein. Other types of auto-antibodies are not a risk factor.