This story about possible links between folic acid supplements and reduced autism risk tries to include enough caveats to put the study results in the proper perspective. Compared to an LA Times story we also reviewed, it is different in detail, but similar in overall effect. Both were better than a competing CNN blog story.
The body of this story clearly makes the point that these researchers went to great lengths to rule out alternative explanations for the data showing that Norwegian women who took folic acid supplements before or early in pregnancy were less likely to have a child later diagnosed with autism. It could have done a better job of explaining why the results may not be relevant to women in the US.
Stories that may encourage millions of people to change behavior in order to possibly, but not certainly, affect a small risk, should proceed with caution. But since folic acid supplementation is already strongly recommended to reduce the risk a baby may be born with spina bifida or other neural tube defects, reporting on this research is important, even if any potential benefit appears to be relatively small and tentative. We appreciate how this story clearly stated that “the new study…doesn’t prove low folic acid in pregnant women causes their babies to develop autism, or that high doses can prevent it.”
Not applicable. The story didn’t discuss costs, but since folic acid supplement pills cost only a few cents each, the omission is not important.
By reporting that the autism rate in the folic acid groups was 1 in 1,000 and in the non-folic acid group was about 2 in 1,000, readers can get a feel for how small the overall differences were between the two groups. However, the story would have been better if it had told readers that the difference between the two groups appeared much smaller after adjusting for education and other maternal characteristics. Nonetheless, the CNN.com story could have learned a lesson from this story’s absolute risk presentation.
This is a tough call.
The US Preventive Services Task Force and other expert bodies state that there is no evidence of potential harm from recommended levels of folic acid supplementation. But there are hypothetical, yet plausible concerns about harmful effects of getting too much folic acid, especially an increase in cancer risk. This is why many countries have not embraced mandatory folic acid fortification of the food supply. The story could have mentioned this.
The point is that there are always potential harms. This is not a risk-free substance. Stories may not always find the time/space to delve into hypothetical/plausible potential harms, but we wish they would. Maybe idealistic, but that’s our stand.
This story tells readers that this type of study cannot prove cause-and-effect. It notes that the researchers performed analyses to try to rule out other possible explanations for the results. This story does a better job than the LA Times story of explaining why the fish oil consumption analysis makes researchers more confident about their findings. However, the LA Times story does a better job with cautionary notes about applying results from Norway to the US; for instance by noting that the Norwegian women who didn’t take folic acid still had a much lower risk of having a child diagnosed with autism than a mother in the US.
This story reports recent statistics about the prevalence of autism in the US and highlights uncertainty about whether the rising rate of diagnoses is due to more careful testing or some actual change in rates.
The story includes a quote from two independent experts, in contrast to the LA Times story we also reviewed. The lack of discussion of potential conflicts of interest does not cause great concern because the researchers did not disclose relevant conflicts and the study was funded by a public agency.
There aren’t any proven strategies to reduce autism risk, although research suggests a link to maternal smoking, the father’s age at conception (older than 40 = higher risk), and exposure to air pollution and pesticides. The story could have mentioned these, but we won’t ding it for not doing so. The best we can rule it is Not Applicable.
It is clear that folic acid supplements are widely available and have long been recommended for women considering pregnancy.
The story reports the long-standing recommendation that women considering pregnancy take folic acid supplements and that many common foods are already fortified with the vitamin. But it could have noted that at least one other study has documented an association between folic acid use and reduced autism risk. The JAMA paper on which the story is based cites several prior research efforts showing association with folate in early pregnancy and severe language delay or autism. That would have helped readers get the broader perspective on past research in this field.
The story does not rely on a news release.