Can PCOS increase the risk for autism?

Autism spectrum disorder (ASD), a very emotionally charged and controversial issue, has spurred numerous studies investigating potential genetic and environmental etiologic factors.  One popular hypothesis is that prenatal androgen (e.g. testosterone) exposure may modify brain development and contribute to the development of ASD.  

The basis for this hypothesis comes from the fact that polycystic ovary syndrome (PCOS), an endocrine disorder affecting ~ 5–15% of women, is characterized by ovarian dysfunction, increased androgen production, and metabolic disturbances such as obesity and insulin resistance.  Women with PCOS manifest increased circulating levels of androgens as well as hyperinsulinemia during pregnancy. This has been associated with abnormal placental steroid production and increased testosterone in amniotic fluid. 

Along these lines, a recently published study from Sweden (see below) postulates a link between maternal PCOS and an increased risk of autism in their children.  In the study, 24,000 children with autism were compared with 200,000 without the disorder from a health and population register database. The study found that children born to mothers with PCOS had a 59% greater risk of autism development - a risk that further increased if the mother was also obese.

So where does this research leave us?  Like many other preliminary studies, it requires confirmation.  And remember that "association" does not mean "causation".  Nevertheless, the study should prompt further investigation into the potential role of sex steroids in the etiology of ASD.

                                                                                                                                        Judith Wolf, MD

                                                                                                                        Associate Director, WHEP

                                                                                                                          

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Kosidou K, Dalman D, Widman L, et al. Maternal polycystic ovary syndrome and the risk of autism spectrum disorders in the offspring: a population-based nationwide study in Sweden.  Molecular Psychiatry (2015), 1–8.   http://www.nature.com/mp/journal/vaop/ncurrent/pdf/mp2015183a.pdf

                                                                                                                     

Someone Like You

Listening to the radio while driving home from work last week I happened upon a SiriusXM “town hall” with music icon Adele during which she answered questions about aspects of her life and career with a natural genuineness, confidence, and common sense.  I’m a huge fan of her music and think she is an amazing lyricist, composer and vocalist.  But what I also admire is how seemingly “down-to-earth” and honest is she when discussing body image.  In the spotlight and constantly critiqued, she gives good advice for all young women to take to heart:

"I do have body image problems for sure but I've had them all my life. There's bigger issues going on in the world than how I might feel about myself."  "There's only one of you, so why would you want to look like anyone else? Why would you want the same hairstyle as everyone else? And have the same opinions as everyone else?"  “The first thing to do is be happy with yourself and appreciate your body-- only then should you try to change things about yourself.”

As she’s said in the past:

“I've always been a size 14-16 and been fine with it. I would only lose weight if it affected my health or sex life”.    "I've seen people where it rules their lives, who want to be thinner or have bigger boobs, and how it wears them down…  And I don't want that in my life. I have insecurities, of course, but I don't hang out with anyone who points them out to me."      

“I like having my hair and face done, but I’m not going to lose weight because someone tells me to. I make music to be a musician not to be on the cover of Playboy”.   

“I like looking nice, but I always put comfort over fashion. I don’t find thin girls attractive; be happy and healthy. I’ve never had a problem with the way I look”.

But given her celebrity, there are plenty of people who have made pointed comments.  For example, Chanel designer Karl Lagerfeld described her as “a little too fat".   And there were comments by others like Joan Rivers: “People got angry about me calling Adele fat, but she is chubby, come on it’s okay… the only book she reads cover to cover is the menu.”

So, how does Adele deal with this?   In a previous interview with Anderson Cooper (https://www.washingtonpost.com/lifestyle/style/adele-on-body-image-female-pop-stars-602/2012/02/13/gIQAOBQWBR_video.html) Adele said she “feels no pressure to be a ‘skinny-mini’ or wear revealing, hyper-sexual clothing…"

In my opinion, however, this is the quote to remember:  “I’ve never wanted to look like models on the cover of magazines. I represent the majority of women and I’m very proud of that.”

And that’s why Adele is ‘someone like you’.

                                                                                                     Judith Wolf, MD                              

                                                                                      Associate Director, WHEP

Fifty Shades of Grey: Young Women, Relationships, and Popular Culture

We are all surrounded and influenced by social media, film, music and music videos.  But few of us stop to think about how portrayal of “traditional” gender roles (the strong, powerful man and weak, submissive woman) affect relationships.  More specifically, what impact do sexual stereotypes, hypersexualized images, violence, stalking, and manipulation have on attitudes and behaviors?   

Interestingly, a recent study published in the Journal of Women’s Health titled “Young Women’s Perceptions of the Relationship in Fifty Shades of Grey,” used focus groups consisting of 18-24 year old women to evaluate young women’s perceptions of the relationship in the film.  What they found was that young women were at the same time fascinated and repulsed.

Here are some excerpts from the study:

“While participants assessed parts of the relationship between Christian and Anastasia as exciting and romantic, they consistently indicated an unappealing lack of health in the relationship as the overarching narrative. Participants identified Christian's controlling, manipulative, and abusive behavior and angry emotions as key contributors to the lack of relationship health, including stalking Anastasia, selling her car without her permission, taking her to a hotel while she was intoxicated and unconscious even though they had little relationship together, buying her expensive gifts to control and manipulate her, and expressing anger in their sexual interactions.”

“At the same time, participants were sympathetic and rationalized Christian's behaviors. … While participants identified Christian's control/manipulation, stalking, emotional abuse, anger, and neglect of Anastasia's needs, they were sympathetic and rationalized these behaviors as a function of his personality, needs, and ability to wield power in the relationship due to his affluence.”

Because of the “sexual abuse he experienced in adolescence”, he “isn't able to have meaningful relationships because he doesn't know how”.

Some study participants blamed Anastasia for not standing up for herself and effectively negotiating her needs:  “You have a voice, you can control it, he told you he is going to do it so if you don't say anything he is going to assume that you are okay … she has to figure out how to communicate … you have your own voice … they have a saying in society, ‘If you're timid, work on that.’”

However, the majority of focus group participants acknowledged the challenges of “speaking up” in a relationship like Christian and Anastasia's.

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It’s important for all of us to become more “media literate” – to be able to analyze and critique the content, stereotypes, and messages in advertisements, music lyrics, movies, and videos.  Moreover, as the authors point out, gender-based violence prevention programs, especially those that target young men, should encourage discussions about the depictions of violence against women, gender and sexual messages, and stereotypes in the popular media.  Lastly, patient education materials about being smart consumers of media (check out the example "nutritional impact" below) should be available to adolescent and young adult patients.  These efforts can all contribute to prevention of violence against women.

 

http://www.bphc.org/whatwedo/violence-prevention/start-strong/Documents/Start%20Strong%20Sound%20Relationships.pdf 

J Women’s Health.  “Young Women’s Perceptions of the Relationship in Fifty Shades of Grey”

Amy E. Bonomi, PhD, MPH, Emily M. Nichols, MSW, Christin L. Carotta, PhD,

Yuya Kiuchi, PhD, and Samantha Perry.  2015; Volume 24. Available on line.

                                                                                             Judith Wolf, MD

                                                                                             Associate Director, WHEP