NEW YORK, – Siblings of children with autism have a higher risk of being diagnosed with the disorder than previously believed, according to a new study.

The analysis of more than 600 three-year-olds with an older, autistic sibling found that almost one in five of them had an autism spectrum disorder, which includes Asperger’s syndrome and similar conditions.

That suggests pediatricians need to keep an extra eye on those siblings, even as toddlers, because early interventions with therapy and extra support might help keep their symptoms to a minimum, researchers said.

“We know that the brain at young ages is more amenable to change,” said study author Wendy Stone of the University of Washington Autism Center in Seattle.

“When children are showing signs (of autism) even before the diagnosis is official, we need to start thinking about how can we help parents within the course of their everyday activities to promote their child’s social and emotional development,” she told Reuters Health.

The findings, she said, also show that autism rates, now estimated at about one in every 110 U.S. kids, probably will not decrease any time soon.

Previous studies estimated that 3% to 14% of autistic children’s younger siblings also had the condition.

Stone and her colleagues had the advantage of a large data set of children with autism and their siblings, including 664 sibling infants seen at 12 different institutions. They recruited the young siblings to the study when most were younger than six months old, before they showed any symptoms.

Around their third birthday, doctors tested each of those children for signs of autism.

By that point, 132 of the siblings, or close to 20%, had developed an autism spectrum disorder, the researchers report in the journal Pediatrics.

Children who had multiple older autistic siblings were twice as likely to be diagnosed with autism as those with only one sibling with autism. As has been shown before, boy siblings were also about three times more likely than girls to have autism.

Researchers have long known that genes play a role in predisposing kids to autism, but it is clear that “genetics is not the whole story,” Stone said, and there are still many unanswered questions about what causes the condition.

The research network is funded by Autism Speaks, an organization that promotes awareness of autism and funds research on prevention and treatment.

GUIDING PARENTS’ DECISION-MAKING

Keely Cheslack-Postava, an autism researcher from Columbia University in New York, said that the rate of autism in siblings may be higher now because the definition of who has an autism spectrum disorder has widened to include more children.

Still, she said, the one-in-five number “for an individual family is somewhat limited in terms of exactly what this information means,” she told Reuters Health.

Stone and her colleagues said it is important that parents of an autistic child have access to genetic counseling if they’re thinking of having another child, but added that it is hard for doctors to evaluate each family’s risk of having another autistic child.

This “puts a much better estimate of risk in the hands of parents and clinicians, so hopefully that will help guide their decision-making more effectively,” said Zachary Warren, head of the Treatment and Research Institute for Autism Spectrum Disorders at the Vanderbilt Kennedy Center in Nashville, Tennessee, one place where children were recruited for the study.

Cheslack-Postava, who did not work on the report, agreed with the authors that one of the key messages from the findings is the importance of early intervention for at-risk siblings.

“The most important public health implication of this higher observed recurrence risk is probably for awareness and attention to development in those children,” she said.

(Editing by Robert MacMillan)

Now that fertility clinics can successfully transfer a single embryo, provinces should seriously consider funding in-vitro fertilization for couples who need it, advocates say.

An analysis prepared for the Infertility Awareness Association of Canada (IAAC) found Ontario would save $533 million in the first five years of funding if the province were to start covering the cost of single-embryo IVF.

IVF is expensive, so many couples currently turn to multiple-embryo IVF to get the most bang for their buck.

This increases a woman’s chance of conceiving, but it also puts her at risk of having more than one baby at a time, which increases the risk of premature birth and health problems for the infants — all of which adds up to increased health-care costs for provinces.

“When patients pay for their fertility treatments, they are financial hostages to the system and are ready to take risks they may not take if they weren’t,” Dr. Annie Janvier of Sainte-Justine hospital in Montreal wrote in the fall edition of IAAC’s magazine. “Couples hope to go through the procedure preferably only once. Therefore, having twins allows them to have their family complete after one cycle only.”

But if IVF was publicly funded, she said patients would be more willing to accept single-embryo transfers.

The IAAC analysis, released in July, found if Ontario funded single-embryo IVF, 2,411 more couples would conceive, and there would be 78% fewer twin births, 100% fewer triplets (and even higher multiples), and 2,954 fewer premature babies annually.

The cost of funding the cycles — estimated at between $90 and $132 million each year — “will be completely offset” by health-care savings, the analysis said.

Beverly Hanck, the executive director for IAAC, said these numbers should help convince politicians to fund IVF treatments.

On Aug. 5, 2010, Quebec began funding up to three treatments of IVF for couples who require it to become pregnant. Since then, the province said it has lowered the number of pregnancies that result in multiple fetuses from 27.2% to 5.2%, and there was a total of 4,867 IVF cycles. The release did not say how many women became pregnant from the treatments.

“If the government wasn’t paying for it, a lot of women wouldn’t be having treatment at all,” Hanck said.

Ontario currently offers three rounds of treatment funding, but only for women who have both Fallopian tubes blocked.

Manitoba offers couples a 40% refund up to $8,000, while New Brunswick has promised a 50% rebate up to $5,000 annually for those who need treatment.

B.C. and Alberta appear to be ready to follow suit, Hanck said. “It’s all going in the right direction.”

NEW YORK – Blood drawn from expectant mothers could offer parents an earlier peek at their baby’s sex than methods currently used in the United States, researchers said on Tuesday.

The test may be particularly valuable for families that harbor sex-linked genetic disorders like hemophilia, they add.

Because such disorders only strike boys, knowing that the baby is a girl could spare the mother diagnostic procedures, such as amniocentesis, that carry a small risk of miscarriage.

“It could reduce the number of invasive procedures that are being performed for specific genetic conditions,” said Dr. Diana Bianchi of Tufts University School of Medicine, who worked on the new study.

The test looks for small pieces of the male sex chromosome in the mother’s blood, which would mean she is carrying a baby boy, as early as seven weeks into the pregnancy. Some European hospitals already rely on the method, called cell-free fetal DNA, although it’s not available from doctors in the United States.

“What they are finding in England is that many women are not going on to have the invasive tests,” Bianchi told Reuters Health.

In those procedures, doctors either extract a small amount of the fluid that surrounds the fetus (amniocentesis) or they take a sample of the placenta (chorionic villus sampling). Between one in 100 and one in 600 mothers miscarry as a result, according to Bianchi.

Some researchers voiced concerns about the test, saying it could be misused to terminate a pregnancy if the baby isn’t of the desired sex.

“What you have to consider is the ethics of this,” said Dr. Mary Rosser, an obstetrician and gynecologist at the Montefiore Medical Center in New York.

“If parents are using it to determine gender and then terminate the pregnancy based on that, that could be a problem,” she told Reuters Health. “Remember, gender is not a disease.”

SOME ROOM FOR ERROR

In a fresh look at the medical evidence for the blood test, Bianchi and her colleagues analyzed 57 earlier studies that included more than 6,500 pregnancies.

They found parents could trust the test 98.8% of the time when it said they would have a boy, and 94.8% of the time when it indicated a girl.

That leaves some room for error, which could be important if parents are making medical decisions based on the results — such as whether to get an invasive procedure to look for genetic disorders.

The current non-invasive alternative — an ultrasound done at the end of the first trimester — isn’t always good at spotting a baby’s sex, Bianchi’s team reported in the Journal of the American Medical Association.

Bianchi said one study had estimated the blood test costs about 255 pounds in the UK (about $407), all included. While it’s available over the Internet, she said her team had only looked at hospital-based test performance.

“I don’t know why it is not being incorporated in the U.S.,” she said.

Rosser, however, chalked that up to the ethical issues it raises.

“It is a great test that can be part of our armamentarium of noninvasive testing that we use,” she said. “But it should only be used by families that are at risk for sex-linked diseases.”

Bianchi said she owns stock in privately held Verinata Health, a company that is developing cell-free fetal DNA tests for Down syndrome, although that company had no role in the new study.

The American College of Medical Genetics did not respond to requests for comment on the DNA tests.

(Editing by Steve Orlofsky)

ATLANTA – U.S. hospitals are not doing enough to encourage mothers to breast-feed their newborns, raising the risk of childhood obesity, diabetes and other conditions, according to a federal study released Tuesday.

Less than 4% of the country’s hospitals fully support breast-feeding, said a report issued by the U.S. Centers for Disease Control and Prevention.

In nearly 80% of hospitals, healthy babies who are being breast-fed are given formula even when there is no medical need for it, making it more difficult to continue breast-feeding at home, the report says.

Only a third of hospitals have “rooming in” policies that allow babies to stay in the hospital room with their mothers 24 hours a day, which can increase breast-feeding opportunities.

Nearly 75% of hospitals do not provide adequate support for mothers once they leave, including follow-up visits and phone calls, the report said.

The American Academy of Pediatrics recommends feeding babies only breast milk until they are six months old and continuing breast-feeding for at least a year. Only 15% of mothers currently breast-feed exclusively for six months, CDC Director Thomas Frieden told reporters Tuesday.

“We’re a very long way from where we need to be,” he said.

Failure to promote breast-feeding costs the U.S. healthcare system $2.2 billion US annually, Frieden said.

If breast-feeding is halted too early, babies have a higher risk of obesity, diabetes, respiratory and ear infections, and sudden infant death syndrome, the CDC said.

“Breast milk does many things,” Frieden said. “It is the perfect nutrition for an infant. The initial breast milk has very important antibodies that are passed to the child. The child cannot make their own antibodies until they are about six months old.”

Studies have shown that children who are breast-fed for at least nine months have a 30% lower chance of becoming overweight compared to children who were never breast-fed, said Frieden.

It is not entirely clear why breast-feeding lowers obesity, he added, describing the relationship between the two as “complex.”

One hypothesis is that when infants are breast-fed, they have more control over the amount they are consuming, said Cria Perrine, a CDC epidemiologist.

Breast-feeding also helps the health of the mother, lowering the risk of breast cancer and ovarian cancer, Frieden said.

The release of the report coincides with World Breast-feeding Week, which the CDC said is being celebrated in more than 170 countries.

(Editing by Colleen Jenkins and Greg McCune)

Researchers in Australia have debunked claims hypoallergenic baby formula will decrease a child’s risk of allergies later in life.

In one of the largest tests of its kind, researchers from the Murdoch Childrens Research Institute had 620 infants drink hypoallergenic formula, cow’s milk, or soy formula after they were no longer breastfeeding. Allergy testing was undertaken at six, 12 and 24 months and children were followed up with again at six or seven years of age.

“In our study of high risk children, this ‘hypoallergenic’ formula did not show any beneficial effect, when compared with a normal cow’s milk-based formula, for the prevention of childhood eczema, asthma or hay fever up to seven years of age,” study author Dr. Adrian Lowe said in a release.

Fellow author David Hill said infants at high risk of developing allergies should continue to breast feed because of “the many known benefits.”

The study appears online in the Journal of Allergy and Clinical Immunology.

Researchers at the University of Michigan believe they have proven that a common household chemical can disrupt thyroid function.

BPA — bisphenol-A — is a controversial type of chemical compound called a phthalate, used in solvents and plastics found in many household items, including plastic water bottles and the linings of canned food. A growing number of scientists and government agencies question its safety.

Canada has declared BPA a toxic substance, and its use is banned in baby bottles in this country and in the European Union. It is thought to play a role in health problems ranging from obesity and erectile dysfunction to neurological disorders and some types of cancer.

The UM researchers compared blood and urine data from 1,346 adults and 329 adolescents.

They concluded that higher concentrations of BPA are associated with decreases in certain thyroid hormones, which regulate a number of body functions including metabolism and reproduction.

While the difference between those with the highest exposure to phthalates and those with the lowest was not more than 10%, “If you think about the entire population being exposed at this level, you’d see many more thyroid-related effects in people,” said the study’s lead author, John Meeker.

The findings appear in the journal Environmental Health Perspectives.

In a separate study, University of Cincinnati researchers found that products marketed as “BPA-free” alternatives are, for the most part, living up to their claims.

Professor Scott Belcher and colleagues found that stainless steel bottles and co-polyester-lined aluminum bottles don’t release BPA; however, aluminum bottles lined with epoxy-based resins still result in BPA contamination of the liquids stored inside them.

There are currently no standards for “BPA-free” labelling of products.

New parents in the U.K. have one more thing to worry about, thanks to new guidelines from the country’s health department — making sure their babies, toddlers and preschool-age kids are getting enough physical activity.

“Physical activity should be encouraged from birth, particularly through floor-based play and water-based activities in safe environments,” the guidelines read.

The guidelines say children under five should do three hours of physical activity every day once they’re able to walk.

Infants who can’t walk aren’t exempt from the guidelines. It’s recommended they do physical activity through “tummy time” — time spent on their stomach, engaging in such activities as rolling and playing on the floor — reaching for and grasping objects, pulling, pushing, playing with other people and parent-and-baby swim sessions.

Parents are also urged to minimize sedentary behaviour in their children under five by reducing the time children spend in baby carriers or seats, reducing the time they spend in baby bouncers or walking aids and reducing the time kids spend in front of the TV or other screens.

The guidelines call for children and teens aged 5 to 18 to do at least 60 minutes and as much as “several hours” of moderate to vigorous physical activity every day. Adults should do 2 1/2 hours of moderate to vigorous physical activity each week, and should aim to do some form of physical activity every day.

Children under five are excluded from Canada’s physical activity guidelines, which call for children ages five to 11 and teens 12 to 17 to do at least 60 minutes of moderate to vigorous physical activity every day. The Canadian guidelines say adults should exercise for 2 1/2 hours each week.

Last week our family celebrated the birth of a beautiful, healthy little boy, my niece’s second child. And, it must be the season because, in the last couple of months, so many friends and relatives are celebrating similar happy events.

Eating well through the nine months of pregnancy came naturally to my niece who has always had a very healthy relationship with food, and while I know there are many factors that predict the health of a newborn, eating well is certainly one of the most important. Here then are some of the keys to a nutritionally healthy pregnancy.

Pregnancy is a great time to get your nutritional house in order. It’s a time when you are really motivated to take care of yourself, when you are eating for both you and the baby and the foods you eat can help keep both of you healthy. Also, if you eat healthily prior to and during pregnancy, you can establish good healthy habits to later pass down to your children.

Consuming a balanced diet, rich in fruits, vegetables, whole grains, healthy fats, calcium rich foods such as dairy or fortified beverages and protein rich foods such as meat, poultry, fish, eggs, nuts, lentils and legumes, is important for pregnancy. There are also several nutrients that are particularly important. Lets look at those:

IRON: Your body uses iron to build the red blood cells that carry oxygen and iron to the baby. In pregnancy, your needs increase as your own blood volume increases, as well as to build iron stores for the baby and replace blood losses at childbirth. Prenatal supplements contain a large amount of iron to help make sure you get enough. Food sources rich in iron include red meat, liver, eggs, fish, beans and lentils, fortified breakfast cereals, nuts, dried fruit and prune juice. Foods rich in vitamin C such as citrus, tomatoes, peppers, berries, broccoli and potatoes enhance iron absorption.

FOLIC ACID: This vitamin is especially important in helping to prevent neural tube defects, birth defects that affect the baby’s brain and spine. All prenatal supplements contain folic acid to make sure you have enough before and during your pregnancy. Foods rich in folic acid include green leafy vegetables, orange juice, peas, asparagus, beans, lentils, fortified flour, pasta and breakfast cereals. Some people may need even more folic acid so talk to your health care provider about how much you should take.

CALCIUM: You need calcium to build your baby’s new bones and to help maintain your own healthy bones. Best calcium sources are milk, yogurt, cheese, fortified soy and rice beverages, fortified orange juice, calcium-set tofu, canned fish with bones, beans and almonds. Prenatal vitamins typically do not have enough calcium to meet your daily needs. If you are not consuming calcium rich foods, speak to your health care provider about a calcium supplement.

VITAMIN D: Vitamin D helps you absorb more calcium and helps to keep your bones strong. Although the sun helps you produce vitamin D in the skin it is only available in the summer months and it is best to get your vitamin D through foods and supplements. Foods rich in vitamin D include milk, fortified soy/rice beverages, fatty fish and egg yolks.

OMEGA-3 FATS: Omega-3 fats are important to help with the development of your baby’s brain, eyes and nervous system. The best sources of omega-3 fats are found in fish. Other sources include canola oil, walnuts, ground flax seeds and foods that are fortified with omega-3 fats such as omega-3 eggs or dairy. Health Canada recommends consuming two servings of fish per week.

Most fish is safe to eat but there are some with high levels of mercury that can harm your baby. Good choices that are low in mercury include anchovy, char, hake, salmon, smelt, rainbow trout, sardines, herring, lake whitefish, mullet, pollock, and Atlantic mackerel.

You should avoid or limit to only once a month shark, marlin, orange roughy, escolar. swordfish and fresh or frozen tuna.

When it comes to canned tuna, you should restrict canned albacore (white) tuna to less than 300 g a week, the equivalent of about two 170-g cans of albacore tuna per week. This advice does not apply to light tuna.

For more information on this issue, go to Health Canada’s website Hc-sc.gc.ca/fn-an/pubs/nutrition/omega3-eng.php.

While at Health Canada’s website, look at Food Safety for Pregnant Women for advice about food handling and foods that are more high risk during pregnancy.

Some foods you should avoid:

– Soft cheeses – feta, brie, camembert, blue veined cheese like Roquefort

– Raw meats including uncooked hot dogs, packaged luncheon meats and non-dried deli meats (unless reheated until steaming hot)

– Raw fish (e.g.sushi, raw oysters, clams, mussels)

– Raw eggs (e.g some Caesar salad dressings, eggnog) or runny eggs

– Unpasteurized dairy products

– Refrigerated pate or meat spreads (canned or shelf-stable products are OK)

– Refrigerated smoked seafood (smoked seafood is safe to eat if it is part of a cooked dish, or if it is canned and shelf-stable).

– Raw sprouts

– Unpasteurized juice and cider

CHICAGO – Environmental factors may play a greater role in autism than previously thought, tipping the scale away from a strict focus on genetics, two studies suggest.

In one, a team at Stanford University compared cases of autism in identical and fraternal twins and found that fraternal twins — who share only half of the same genes — have unusually high rates of autism, suggesting that factors other than genetics may be triggering the disease.

In another, researchers at health insurer Kaiser Permanente found mothers of children with autism were twice as likely to have been prescribed a common antidepressant during the year before their pregnancy than mothers of healthy children.

And the risk was even greater — a threefold increase — when the drug was taken in the first trimester of pregnancy.

The findings, released in the Archives of General Psychiatry, suggest that something in the birth environment — drugs, chemicals or infections — may be triggering autism in children who are already genetically predisposed to develop the disease.

“It has been well-established that genetic factors contribute to risk for autism,” Clara Lajonchere, a study co-author and vice president of clinical programs for Autism Speaks, said in a statement.

“We now have strong evidence that, on top of genetic heritability, a shared prenatal environment may have a greater than previously realized role in the development of autism.”

Autism is a spectrum of disorders ranging from a profound inability to communicate and mental retardation to relatively mild symptoms such as with Asperger’s syndrome.

It affects one in every 150 children born today in the United States, or about 1% of the population.

SHARED ENVIRONMENT

The Stanford study involved 54 pairs of identical twins, who share 100% of the same genes, and 138 pairs of fraternal twins, who share half of the same genes.

In each pair, at least one of the twins had been diagnosed with autism.

The researchers found the chances of both children having autism spectrum disorder was higher among identical twins than among fraternal twins. But fraternal twins were much more likely to develop autism than studies of children in families where a sibling has autism.

According to the study, environmental factors common to twins explain about 55% of the cases of autism, and while genetic factors still play a role, it is much lower than seen in other studies of twins and autism.

“Environmental factors play a bigger role than previously thought,” said Dr. Joachim Hallmayer of Stanford University School of Medicine in California, who led the study.

Recent studies have suggested genetics played the biggest role in autism, but his findings suggest something different, he said in a telephone interview.

“We have to study both the genetics and the environment,” Hallmayer said. “If we look only at one side, I don’t think that will lead us to the right answer.”

COULD IT BE ANTIDEPRESSANTS?

In a separate study in the same journal, a team led by Lisa Croen, director of the Autism Research Program at the Kaiser Permanente Division of Research in Oakland, California, looked to see whether antidepressants known as selective serotonin reuptake inhibitors, or SSRIs, contributed to autism risk.

The team studied nearly 300 children with autism and 1,500 randomly selected children and then checked their mothers’ medical records.

They found mothers of the children with autism were twice as likely to have taken an antidepressant in the year before delivery than children in the control group.

And the effect was strongest — three times higher — when the drugs were taken in the first trimester of pregnancy.

“Our results suggest a possible, albeit small, risk to the unborn child associated with in utero exposure to SSRIs,” Croen said in a statement.

But she said this risk must be balanced with the risk to the mother of having untreated depression.

The team cautioned that the SSRI study was preliminary and said much more work was needed to understand the link between antidepressants and autism.

“There are real risks to not being treated for a serious illness like depression. You have to weigh the options,” said Dr. Thomas Insel, director of the National Institute of Mental Health.

“A threefold increase in risk is not insignificant. It is worth taking that into account with other factors,” Insel said in a telephone interview.

Insel, whose agency funded the twins study, said it is not yet clear what environmental factors may be triggering autism.

“It could be a range of things from infection to chemical exposures. We simply don’t know.”

What is becoming clear, he said, is that the exposure is likely occurring before childbirth.

“From all the studies that so far have concluded, that is where the evidence seems to be going,” he said.

(Editing by Doina Chiacu)

LONDON – Researchers studying autistic toddlers have discovered their brain activity appears to be out of sync at a very early stage — a finding that sheds light on the biology of the condition and may help in earlier diagnosis.

In research published in the journal Neuron, scientists in Israel used functional magnetic resonance imaging (fMRI) to look at the brains of sleeping toddlers and found that certain types of neural activity are disrupted in autistic children but not in typical children or in others with delayed language development.

“What we looked at is how the activity is synchronised,” Ilan Dinstein of Weizmann Institute of Science in Israel, who led the study, said in a telephone interview.

“And we found that the synchronisation was different — specifically in toddlers with autism and across the hemispheres (of the brain) in areas related to language and communication.”

Autism is a complex and mysterious brain disorder usually first diagnosed in early childhood. It is characterised by difficulties in social interaction, communication, and understanding other people’s emotions and behaviour.

Autism disorders are diagnosed in up to one in 100 children in the United States and Europe and affect four times as many boys as girls, but the condition is very often misdiagnosed and doctors are keen to find biological measures to help pinpoint diagnosis and make it more accurate.

“There’s a tremendous amount of misdiagnosis in many different forms,” Dinstein said. “A child that might seem autistic at one and a half years old may turn out at three years old to have language delay or some other developmental disorder. So one of the reasons to look for a biological measure is to clarify the issue of diagnosis very early on.”

The human brain is split into two separate hemispheres, which are mostly symmetrical in terms of anatomy and function.

Dinstein explained neural activity continues even during sleep and in a typical brain, normally correlates to certain patterns. Scientists believe the strength of synchronisation between functionally related areas in the right and left hemispheres may be a measure of how well the brain is working.

Dinstein’s team recorded brain activity in sleeping toddlers with typical development, language delay, and autism.

Their results showed a specific abnormality in synchronisation between two brain areas commonly associated with language and communication in 70 percent of toddlers with autism, but only in a handful of the typically developing toddlers or those with language delay.

Dinstein said that as a potential diagnostic tool, this biological measure was “a first step”.

He said another useful aspect of this measure was its ability to be taken during natural sleep, bypassing potential problems of getting a very young child to cooperate with a test.

(Editing by Jan Harvey)