Patients Connect

Taking folic acid during early pregnancy may reduce risk of autism disorders

Women who take prenatal folic acid supplements before they get pregnant or early in their pregnancy could lower their risk of autism, a recent study published in the February issue of the Journal of the American Medical Association.

Researchers looked at 85,176 babies born from 2002 to 2008 for 3 to 10 years to determine if moms who used folic acid supplements influenced the risk of developing an autism spectrum disorder.

Autism spectrum disorders are a group of disorders that affects the normal development of the brain in areas of social interaction, communication skills and behavioral function. Disorders include autistic disorder, Asperger’s Syndrome and Pervasive Developmental Disorder, also called atypical autism.

Researchers paid particular attention to women who had taken folic acid for 4 weeks before pregnancy to 8 weeks after the start of pregnancy. Babies in the study were from the Autism Birth Cohort Study, a subset of the Norwegian Mother and Child Cohort Study.

Researchers identified a total of 270 cases of autism spectrum disorders in the study population (114 autistic disorder; 56 Asperger syndrome; 100 atypical autism).

Moms who took folic acid supplements in early pregnancy had a 40% reduced risk of having children with autistic disorder compared with moms who did not take folic acid. No reduction in risk was seen for Asperger syndrome or atypical autism.

"There was a dramatic reduction in the risk of autistic disorder in children born to mothers who took folic acid supplements,” Pål Surén, the study’s first author and an epidemiologist at the Norwegian Institute of Public Health, said in a statement.

But the study’s findings do not prove a cause and effect link between folic acid use and ASD, study authors noted.

Currently, an estimated 1 in 88 children in the U.S. have been identified with an Autism Spectrum Disorder, according to the Centers for Disease Control and Prevention (CDC).  Autistic disorders are about 5 times more common among boys than girls.

Recently, researchers have started to investigate whether folic acid has other beneficial effects besides protecting the development of the fetus' brain and spinal cord.

A separate 2011 study from the University of California, Davis, showed a lower risk of autism spectrum disorders in children of moms who had used prenatal vitamin supplements during pregnancy.

According to senior author Ezra Susser, professor of Epidemiology at Columbia University's Mailman School of Public Health in New York, the current study raises the possibility of using an inexpensive alternative for reducing the burden of autism spectrum disorders.

Insomnia May Be Responsible for Hundreds of Thousands of Dollars Worth of Workplace Accidents Each Year

By: Barbara Sadick

Insomnia may be responsible for more than 274,000 or $31.1 billion worth of workplace accidents a year, according to a recent study published in the October 2012 issue of Archives of General Psychiatry.

Researchers found that the average cost of insomnia related errors each year is $32,000 as compared with $22,000 in accidents and mistakes caused by those who don’t suffer from insomnia.  Insomnia is associated with 7.2 percent of costly workplace accidents and with 23.7 percent of the costs of all workplace accidents and errors.  Overall, 10-15 percent of these errors are a direct result of insomnia.

Insomnia is a disorder that makes it hard to fall asleep or stay asleep or both.  Those who suffer from it usually awake without feeling rested.  The disease not only depletes energy and mood, it affects health, work performance and quality of life.  According to the CDC, about one in three Americans don’t get enough sleep. Healthy People, the nation’s ten-year health goals, calls for a decrease in sleep deprivation by the year 2020.

Jaspal Singh, Medical Director of Carolinas Health Care System Sleep Services, says insomnia is as debilitating as being drunk.  “Driving sleep deprived is just as hazardous as driving drunk,” he says.  He explains that there are four levels of sleep, with the fourth being REM (Rapid Eye Movement) sleep.  “If we don’t get REM sleep,” he continues, “which makes up about 25 percent of the sleep cycle, the effects will be felt even when someone sleeps for seven or eight hours a night.”

Nearly 5,000 of the 10,000 individuals who were contacted by phone responded to the study survey.  Participants were found through claims records and data from the American Insomnia Survey, a nationwide phone survey.  Individuals chosen to be part of the study included only those who were covered by health insurance and spoke English. They were asked if they had ever had a workplace accident that had caused damage or disruption of work and had cost an employer $500 or more.  Of the 20 percent who said they’d experienced symptoms of insomnia that lasted for more than a year, 4.3 percent said they’d made a serious error or had an accident at work.

Findings showed that 5.5 percent of those who suffered from insomnia said their accidents and errors in the workplace had cost at least $500 compared with 4 percent who didn’t have insomnia.  Insomniacs were almost twice as likely as others to make an error or have an accident at work.

“This work is extremely important,” says Shelby Harris, PsyD, Director of the Behavioral Sleep Medicine Program at Montefiore Medical Center.  “It helps by giving more specific rates of insomnia and insomnia-related errors in the U.S. workforce, highlighting that it is an extremely important problem in our society that is not getting sufficiently addressed.”  She says that effective treatment exists for sleep problems, and early detection is key in helping reduce overall healthcare costs as well as costs to the employer.

Harris points out that a possible study limitation might be that only 65% of those questioned actually responded to the survey, suggesting a possible distortion of the estimate.  She also notes that those who were surveyed were all insured, raising questions about the 15 percent of Americans who don’t have commercial health care coverage. “However,” she says, “the study furthers the initial work in this realm done in France which showed major decrements in workplace functioning.”

This is the largest study to date to look at insomnia in the workforce, and researchers suggest that if employers were to screen and treat insomnia, accidents and sick days from work might be reduced.

Diet drinks linked to increased risk of depression, coffee tied to lower risk

Drinking sweetened beverages, like diet drinks, may lead to increased risk of depression in adults, according to a study that will be presented at the American Academy of Neurology's 65th annual meeting in March 2013.

Researchers also found that drinking coffee was tied to a lower risk of depression.

"Sweetened beverages, coffee and tea are commonly consumed worldwide and have important physical—and may have important mental—health consequences," said study author Honglei Chen, MD, PhD, with the National Institutes of Health in Research Triangle Park in North Carolina.

The study included more than 260,000 people between the ages of 50 and 71. From 1995 to 1996, researchers looked at how much the study participants drank soda, tea, fruit punch and coffee.

About 10 years later, researchers asked participants whether they had been diagnosed with depression since the year 2000. A total of 11,311 depression diagnoses were made.

They found that people who drank more than four cans or cups of soda a day were 30 percent more likely to develop depression than those who drank no soda. Those who drank four cans of fruit punch a day were about 38 percent more likely to develop depression than those who did not drink sweetened drinks.

But people who drank four cups of coffee a day were about 10 percent less likely to develop depression than those who drank no coffee.

Although Chen did point out that caffeine acts as a central nervous system stimulant, how it plays a role in depression is still unclear.

"More research is needed to confirm these findings, and people with depression should continue to take depression medications prescribed by their doctors," he said.

Vitamin D Appears Not To Relieve Symptoms of Osteoarthritis

By: Barbara Sadick

Vitamin D does not appear to either relieve pain or slow down the loss of cartilage in patients with osteoarthritis, according to a recent study published in the January 9, 2013 issue of The Journal of the American Medical Association (JAMA).

Knee osteoarthritis is a degenerative disease of the knee joint that is due mostly to aging and to wear and tear on the joint.  It usually appears in middle age and the cause is not known. It does tend to run in families and its risk is greater in those who are overweight, because extra weight puts more pressure on the knee, causing greater stress and degeneration. 

Pain and stiffness in the knee joints are the most basic symptoms.  There is no cure to date for knee osteoarthritis, but treatments, including medication, acupuncture, and surgery, can alleviate some of the pain.  Many who suffer from knee osteoarthritis are treated with physical therapy.

Treatment for osteoarthritis usually is to alleviate pain with over the counter medication or with steroid injections.  Moderate exercise and physical therapy often helps also. 

Lead study author Timothy McAlindon, a rheumatologist at Tufts Medical Center in Boston, specializing in arthritis and autoimmune rheumatic disorders was hopeful about vitamin D.

“It looked compelling at that point,” says McAlindon, “and because vitamin D broadly is the vitamin of the moment, there were and still are hopes that it will have wide health benefits.”

In this study, 145 patients with an average age of 62 were divided into two groups.  For two years, one group was given a daily dose of vitamin D and the other was given a daily placebo.  Nobody from either group knew if s/he was receiving the vitamin D or the placebo.

Those participants who were being given vitamin D took about 2,000 international units (IU) a day, and sometimes the dosage was increased to as much as 8,000 IU a day.  The average daily recommend dose for adults is between 600 and 800 IU.

The Vitamin D group began the study in slightly worse condition than the placebo group.  Study researchers used a scale of 0-20 to indicate any change in pain, and result showed that those taking vitamin D had a pain decrease of 2.3 during the two years compared to the placebo group that had a decrease of 1.5 during the same time.  These findings, though, are not significant and study authors think they may be due to chance.

At the end of the two-year period, knee cartilage volume or the measure of the progression of osteoarthritis were similar in both groups.  Knee MRIs showed no differences between the groups in the volume of the cartilage.

Lisa Mandl, MD, MPH, a rheumatologist at New York City’s Hospital for Special Surgery, a hospital that specializes in orthopedics and rheumatology, and an Assistant Research Professor of Medicine at Cornell University, praises the design of the study.  “It’s an important study,” she says, “because every one is saying to take vitamin D.  While it may be beneficial for other reasons, it doesn’t impact the progression of osteoarthritis.”

“More helpful for painful knee osteoarthritis,” says Mandl, “is to focus on physical therapy and when needed, weight loss.”  She notes that the study’s focus was on pain and cartilage loss, and looked only secondarily at function.

Elaine Husni, MD, MPH, Director of The Arthritis and Musculoskeletal Treatment Center at the Cleveland Clinic in Ohio says the study is important because it raises awareness about bone health in patients with osteoarthritis.  “There may be other ways of improving bone health,” she says, “but it doesn’t look like vitamin D supplementation is the answer.”

Husni says treatment does exist to for osteoarthritis, and that those who suffer from it should see a rheumatologist to determine exactly where the pain is coming from and how advanced the cartilage degeneration is.  “There are ways to reduce pain and joint function,” she says.  “For those who weigh more, losing weight will relieve some pain and physical therapy can decrease stress on the knee joint by improving flexibility and strength of muscles and tendons around the joint,” she continues, “and there are anti-inflammatory drugs and injection therapies available.”  For now, there doesn’t appear to be any miracle cure.