2nd Department of Pediatrics, School of Medicine, Aristotle University of Thessaloniki, University General Hospital AHEPA, Thessaloniki, Greece.
Laboratory of Pharmacology, School of Medicine, Democritus University of Thrace, Alexandroupolis, Greece.
J Am Coll Nutr. 2020 Mar-Apr;39(3):261-271. doi: 10.1080/07315724.2019.1635920. Epub 2019 Jul 18.
Nutritional interventions are gaining remarkable attention as complementary management options for autism. Our aim is to provide literature data about the impact of the administration of dietary supplements during pregnancy on the risk of autism spectrum disorder in the offspring. A comprehensive search was undertaken by 2 reviewers independently using PubMed as the medical database source. Prospective clinical and experimental studies were considered and no year-of-publication restriction was placed. We were able to identify 4 basic (conducted in rodents) and 3 clinical research papers fulfilling our selection criteria. Supplements studied included folic acid, iron, multivitamins, choline, vitamin D, and docosahexaenoic acid. Choline and folic acid had a significant impact on the expression of autism-related genes. However, from a clinical point of view, prenatal folate administration did not reduce the risk of autism. Similarly, iron had no significant impact, while the use of multivitamins in moderate frequency had a protective effect. The use of vitamin D and docosahexaenoic acid during gestation decreased the incidence of autism in animal models. In conclusion, available data are controversial and cannot change current routine practice. More large-scale prospective studies are needed to identify the real effect of nutritional supplements and also optimize their administration.Key teaching pointsMultivitamins use during pregnancy can exert a protective effect on the risk of autism, although depending on the frequency of use. Nevertheless, prenatal iron and folate were not shown to have any significant impact.Research based on animal models showed that choline and folic acid can have a significant impact on the expression of autism-related genes in a sex-specific manner.Furthermore, the use of vitamin D and docosahexaenoic acid during gestation seem to decrease the incidence of autism in animal offspring.In the future, more clinical, large-scale prospective and methodologically homogenous clinical studies are needed to further investigate the effect of the periconceptional use of nutritional supplements on autism risk.
营养干预作为自闭症的补充治疗方法正受到越来越多的关注。我们的目的是提供有关在怀孕期间服用膳食补充剂对后代自闭症谱系障碍风险影响的文献数据。两名审查员独立使用 PubMed 作为医学数据库源进行了全面搜索。考虑了前瞻性临床和实验研究，并且没有对发表年份进行限制。我们能够确定 4 项基础研究（在啮齿动物中进行）和 3 项符合我们选择标准的临床研究论文。研究中使用的补充剂包括叶酸、铁、多种维生素、胆碱、维生素 D 和二十二碳六烯酸。胆碱和叶酸对自闭症相关基因的表达有显著影响。然而，从临床角度来看，产前叶酸的给予并不能降低自闭症的风险。同样，铁没有显著影响，而中等频率使用多种维生素具有保护作用。怀孕期间使用维生素 D 和二十二碳六烯酸可降低动物模型中自闭症的发病率。总之，现有数据存在争议，不能改变当前的常规实践。需要进行更多大规模的前瞻性研究，以确定营养补充剂的真正效果，并优化其使用。
主要教学要点
怀孕期间使用多种维生素可能对自闭症风险具有保护作用，但取决于使用频率。
然而，产前铁和叶酸并没有显示出任何显著影响。
基于动物模型的研究表明，胆碱和叶酸可以以性别特异性的方式对自闭症相关基因的表达产生重大影响。
此外，怀孕期间使用维生素 D 和二十二碳六烯酸似乎可以降低动物后代自闭症的发病率。
未来需要进行更多的临床、大规模前瞻性和方法学同质的临床研究，以进一步研究围孕期使用营养补充剂对自闭症风险的影响。
