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US Autism & Asperger Association

October 29, 2013

Welcome to USAAA WeeklyNews, an email newsletter that addresses a range of topics on autism, Asperger Syndrome, PDD, and other related disorders.

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Response to Pediatrics article "Maternal Prenatal Weight Gain and ASD"

By Phillip C. DeMio, MD
Chief Medical Officer, US Autism & Asperger Association

pregnancyThe journal article by Dr. Deborah Bilder, et al, in the November, 2013 edition of Pediatrics discusses weight gain in pregnancy as being associated with autism. It essentially says that the more weight a woman gains in pregnancy, the greater the chance is that the child from that pregnancy will be affected by autism. It also says that the prepregnancy Body Mass Index (BMI) (the authors' chosen measure of overweight in prepregnancy) does not matter for the child’s chances of ASD.

"Our own experience is that many of the mothers of individuals with autism are small, often being unusually short, or with normal height but they have unusually small bones. This isn't picked up by the BMI choice made by the authors regarding a mother's prepregnancy status."

They discuss shifting hormones as a plausible basis for the weight connection, and they also acknowledge that autism is on the rise. The authors caution that no one should make any changes based on the above findings, i.e., that it's all preliminary. I and all of us appreciate any information on causes (the authors don't touch cause & effect) of ASD. Let's look at some details on this issue from the article and from what's already known from other realms.

"Furthermore, for twins, or higher multiple births, are an even greater relative gain. It may not at all be the gain in pounds, but the proportion it is of the mom's size (factors she can't control) that is important."

In my practice we've looked at the prepregnancy size of the mom (not her BMI) as a risk for ASD. Our own experience is that many of the mothers of individuals with autism are small, often being unusually short, or with normal height, but they have unusually small bones. This isn't picked up by the BMI choice made by the authors regarding a mother's prepregnancy status. So at my practice we find that the child of the small mom is at risk for ASD.

For example, a 100 pound woman (prepregnancy weight) who has the average 21 pounds pregnancy weight gain, has more than 20% weight increase, whereas in the 200 pound mom it's half that. The BMI does not give regard to the height, while the small-size concept takes a proportional view. Perhaps the small mom, who received the same dose of flu vaccine* as Shaquille O'Neal, or who had the same dose of the anti-rho(D) immune globulin shot (eg, Rhogam®)* as what a 250 pound woman receives, is more easily overloaded (compared to not-so-small women) with toxins that are transferred in pregnancy. Also, the woman who gains more pounds will have a greater chance of high blood pressure or of diabetes during pregnancy, which are each known as independent risks to the fetus (including that for developmental delay). We find the denominator (size of the mom) is very important and that it's not so much the numerator (pounds of weight gain). Furthermore, for twins, or higher multiple births, are an even greater relative gain. It may not at all be the gain in pounds, but the proportion it is of the mom's size (factors she can't control) that is important.

"It would do well for all of us to politely recognize that parents (especially women) feel guilty enough about being told they've caused their child's autism, without the rather cold announcement that the latest factor is gaining weight in gestation."

It would do well for all of us to politely recognize that parents (especially women) feel guilty enough about being told they've caused their child's autism, without the rather cold announcement that the latest factor is gaining weight in gestation. We simply have not found a 30% increase in the chance of a woman's child developing ASD by an extra pound here or there when she's pregnant. I would add parenthetically that thirty years ago our medical student training emphasized how being underweight and being exposed to toxins led to the worst pregnancy outcomes for the child & mother. Maybe that's out of style (except in my practice), but I think it's simply sensible that we don't want extremes of high or low gain in a hopefully healthy pregnancy & childbirth.

"I would add parenthetically that thirty years ago our medical student training emphasized how being underweight and being exposed to toxins led to the worst pregnancy outcomes for the child & mother. Maybe that's out of style (except in my practice), but I think it's simply sensible that we don't want extremes of high or low gain in a hopefully healthy pregnancy & childbirth."

About Phillip DeMio, MD
Dr. Phillip C. DeMio is Chief Medical Officer of US Autism & Asperger Association. He is Medical Director at the Whole Health & Wellness Centers located in Cleveland and Columbus, Ohio. His practice focuses on the diagnosis and treatment for individuals with Autism Spectrum Disorders. He is an ER Physician at Case Western University Hospitals. Dr. DeMio has been a faculty member at several teaching hospitals including Case Western University School of Medicine and the Cleveland Clinic Foundation. Dr. DeMio is Board-certified by the American Board of Emergency Medicine. He founded the American Medical Autism Board. Dr. DeMio is a parent of a child affected by autism.

*Brands & products neither endorsed nor refuted

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VCU Study: Job Training Improves Employment Chances For Youth With Autism

By Mike Frontiero
VCU School of Education

vcu logoA Virginia Commonwealth University study shows intensive job training benefits youth with Autism Spectrum Disorders (ASD), one of the most challenging disabilities for job placement with an employment rate of approximately 20 percent.

Published in the Journal of Autism and Developmental Disorders, the study demonstrates that nine months of intensive internship training, in conjunction with an engaged hospital, can lead to high levels of competitive employment in areas such as cardiac care, wellness, ambulatory surgery and pediatric intensive care units.

"This is the first study of its kind to demonstrate the skills and abilities youth with ASD have and the success they can experience at work," said Paul H. Wehman, Ph.D., principal investigator of the study and professor of physical medicine and rehabilitation and director of the VCU Autism Center at the VCU School of Education. "Previous research in this area showed that youth with ASD were employed at lower rates than even their peers with other disabilities." FULL STORY.

"Through this study, we were able to demonstrate that youth with ASD can be successful employees."

Youth with autism were employed in jobs not typically considered for those with disabilities in a hospital setting. They worked 20 to 40 hours per week and were paid 24 percent more than minimum wage.

FULL STORY
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In this issue:
logoHealth News
Response to Pediatrics article "Maternal Prenatal Weight Gain and ASD"


logoEducation News
VCU Study: Job Training Improves Employment Chances For Youth With Autism


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