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