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BMJ. 2017 Oct 4;359:j4273. doi: 10.1136/bmj.j4273.

Antenatal nutritional supplementation and autism spectrum disorders in the Stockholm youth cohort: population based cohort study.

Author information

1
Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, 3215 Market St, Philadelphia, PA, 19104, USA.
2
Public Health Epidemiology, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
3
Centre for Academic Mental Health, School of Social and Community Medicine, University of Bristol, Bristol, UK.
4
AJ Drexel Autism Institute, Philadelphia, PA, USA.

Abstract

Objective To determine whether nutritional supplementation during pregnancy is associated with a reduced risk of autism spectrum disorder (ASD) with and without intellectual disability in offspring.Design Observational prospective cohort study using multivariable logistic regression, sibling controls, and propensity score matching.Setting Stockholm County, Sweden.Participants 273 107 mother-child pairs identified through population registers. The study sample was restricted to children who were aged 4 to 15 years by the end of follow-up on 31 December 2011 and were born between 1996 and 2007.Exposures Multivitamin, iron, and folic acid supplement use was reported at the first antenatal visit.Main outcome measure Diagnosis of ASD with and without intellectual disability in children determined from register data up to 31 December 2011.Results Prevalence of ASD with intellectual disability was 0.26% (158 cases in 61 934) in the maternal multivitamin use group and 0.48% (430 cases in 90 480) in the no nutritional supplementation use group. Maternal multivitamin use with or without additional iron or folic acid, or both was associated with lower odds of ASD with intellectual disability in the child compared with mothers who did not use multivitamins, iron, and folic acid (odds ratio 0.69, 95% confidence interval 0.57 to 0.84). Similar estimates were found in propensity score matched (0.68, 0.54 to 0.86) and sibling control (0.77, 0.52 to 1.15) matched analyses, though the confidence interval for the latter association included 1.0 and was therefore not statistically significant. There was no consistent evidence that either iron or folic acid use were inversely associated with ASD prevalence.Conclusions Maternal multivitamin supplementation during pregnancy may be inversely associated with ASD with intellectual disability in offspring. Further scrutiny of maternal nutrition and its role in the cause of autism is recommended.

PMID:
28978695
[Indexed for MEDLINE]

Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

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