The Link between Oral Contraceptives Use and Increased Prevalence in Autism Spectrum Disorder
Presentation by: Kim Strifert
The Link between Oral Contraceptive Use and Increased Prevalence in Autism Spectrum Disorder
My Observation
The Link between Oral Contraceptive Use and Increased Prevalence in Autism Spectrum Disorder
• Complex neurodevelopmental disorder
• Social impairments, communication difficulties, and restricted, repetitive, and stereotyped patterns of behavior.
• 1-68 children
• Increased prevalence
The Link between Oral Contraceptive Use and Increased Prevalence in Autism Spectrum Disorder
The Link between Oral Contraceptive use and Increased Prevalence in Autism Spectrum Disorder
• Identification, screening, diagnostic criteria, awareness• Genetic variation• Environment
The Link between Oral Contraceptive Use and Increased Prevalence in Autism Spectrum Disorder
• Preterm birth weight, low birth weight• Multiple birth, breech presentation, cesarean delivery• Assisted reproductive technology• Parental age• Socioeconomic inequalities• Parental exposure to occupational chemicals, pesticides• Living close to freeways• Folic acid• MMR vaccine, Thimerosal• Acetaminophen, excessive multivitamins• Dietary factors
The Link between Oral Contraceptive Use and Increased Prevalence in Autism Spectrum Disorder
The Link between Oral Contraceptive Use and Increased Prevalence in Autism Spectrum Disorder
The Link between Oral Contraceptive Use and Increased Prevalence in Autism Spectrum Disorder
The Link between Oral Contraceptive Use and Increased Prevalence in Autism Spectrum Disorder
Method
No. of users (in 1000s)
% of all women 15-44
% of all contraceptiveusers
Pill (COC’s 10,540 17.1 27.5Tubal Ligation 10,200 16.5 26.6Male Condom 6,280 10.2 16.3Vasectomy 3,860 6.2 10.0IUD 2,140 3.5 5.6Withdrawal 1,990 3.2 5.2Injectable 1,450 2.4 3.8Vaginal Ring 830 1.3 2.2Patch 290 0.5 0.7Implant 180 0.3 0.5Fert. Awareness 440 0.7 1.1Other Methods** 200 0.3 0.5No Method 23,360 37.8 Total # women 15-44 61,750 100.0 100.0
Sexually active women who have ever used COC’s***
50,635 82 82
Adapted from Guttmacher Organization, Mosher and Jones (2010) Vital Health Statistics
The Link between Oral Contraceptive Use and Increased Prevalence in Autism Spectrum Disorder
How do oral contraceptives work?
• Progestins suppress ovulation, the release of the egg, and thicken the mucus of the cervix.
• Estrogen augments the action of the progestogenic compound and stabilizes the endometrium.
The Link between Oral Contraceptive Use and Increased Prevalence in Autism Spectrum Disorder
The Link between Oral Contraceptive Use and Increased Prevalence in Autism Spectrum Disorder
Progestogen negative feedback reduces the pulse frequency of GnRH release by the hypothalamus which decreases the secretion of follicle-stimulating hormone (FSH) and significantly decreases the secretion of luteninzing hormone (LH) by the anterior pituitary. Diminished levels of FSH inhibit follicular development and prevent an increase in circulating blood levels of estradiol. Progestogen negative feedback and the absence of estrogen positive feedback on LH secretion inhibit LH surge in mid-cycle. Inhibition of follicle development and lack of LH surge prevents ovulation.
The Link between Oral Contraceptive Use and Increased Prevalence in Autism Spectrum Disorder
Ethinylestradiol is an Endocrine Disrupting Compound (EDC)
The Link between Oral Contraceptive Use and Increased Prevalence in Autism Spectrum Disorder
EDCs have the same attributes as hormones:
• Ability to be active at low concentrations
• Ability to bind to receptors at very low concentrations
• Ability to interact with multiple hormone receptors concurrently
• Work simultaneously to create additive or synergistic effects not observed with individual compounds
• Often not feasible to extrapolate low-dose effects from high-dose effects of EDCs
The Link between Oral Contraceptive Use and Increased Prevalence in Autism Spectrum Disorder
World Health Organization
State of the Science of Endocrine Disrupting Compounds 2012
The Link between Oral Contraceptive Use and Increased Prevalence in Autism Spectrum Disorder
Exposure Timing
Before Fertilization
After Fertilization
Transgenerational transmission of modified epigenetic programming
The Link between Oral Contraceptive Use and Increased Prevalence in Autism Spectrum Disorder
Oral Contraceptives are Marketed as Safe and EffectiveBut Are They ?
The Link between Oral Contraceptive Use and Increased Prevalence in Autism Spectrum Disorder
The Link between Oral Contraceptive Use and Increased Prevalence in Autism Spectrum Disorder
Lack of Comprehensive Research into Potential Neurodevelopmental effects of Contraceptives
The Link between Oral Contraceptive Use and Increased Prevalence in Autism Spectrum Disorder
• Temporal correlation between use of oral contraceptives and increased prevalence of ASD.
• To date no definitive cause or contributing factors for increase in ASD prevalence has been established.
• Oral contraceptives disrupt the endocrine system – COC’s are endocrine disruptors.
• Oral contraceptives directly and deleteriously affect both the ovaries and ova.
• Likely effects of oral contraceptives on progeny are an open question.• The called-for further study and controlled follow-up of the possible
transgenerational effects of oral contraceptive use has not been executed.
The Link between Oral Contraceptive Use and Increased Prevalence in Autism Spectrum Disorder
Multi-Hit Model of Autism Risk
CombinedOral
Contra-ceptives
GeneticsEnvironmentEpigenetics
?Other
Factors
ASD
The Link between Oral Contraceptive Use and Increased Prevalence in Autism Spectrum Disorder