Nilfer ŞAHİN, Damla BALKAN, Ulviye KIRLI

Otizm Spektrum Bozukluğu Olan Olgularda Anne Sütü Alım Süreleri ve Otizm Şiddetiyle İlişkisi

Otizm Spektrum Bozukluğu (OSB), sosyal etkileşim ve iletişimde bozulmalar ve stereotipik davranışlarla karakterize bir grup nörogelişimsel bozukluktur. Otizm etyolojisi henüz tam olarak aydınlatılamamış olmakla birlikte otizm etyolojisini açıklamak için birçok hipotez öne sürülmüştür. Anne sütü alım süreleri, zamanlamaları gibi emzirme ile ilgili durumlar, otizm için çevresel risk faktörleri olarak öne sürülmüştür. Bu çalışmada OSB’li çocuklarda anne sütü alım sürelerinin otizm şiddetiyle ilişkisinin değerlendirilmesi amaçlanmıştır. Çalışmaya DSM-5 tanı kriterlerine göre OSB tanısı almış 88 çocuk ve yaş ve cinsiyet olarak eşleştirilmiş 61 sağlıklı çocuğun verileri dahil edildi. Otizm şiddeti Çocukluk Otizm Dereceleme Ölçeği (ÇODÖ) ile değerlendirildi. OSB grubunda ortalama anne sütü alma süresi 12.97±8.13 ay iken kontrol grubunda bu süre 15.55±7.81 ay idi. Gruplar arasında ortaya çıkan bu fark istatistiksel olarak anlamlı değildi (p=0.055). OSB grubunda ÇODÖ puanlarıyla anne sütü alım süreleri arasında negatif korelasyon saptandı (p<0.001, r:-0.435). Bu çalışmada OSB’li çocuklarda anne sütü alım süreleri sağlıklı kontrollere benzer bulundu. Bununla birlikte OSB’li çocuklarda anne sütü alım süreleri kısaldıkça OSB şiddetinin arttığı bulundu. Anne sütünün OSB etiyolojisindeki potansiyel patofizyolojik rolünün ve hastalık şiddetiyle ilişkisinin aydınlatılması için daha geniş çaplı çalışmalara ihtiyaç vardır.

Anahtar Kelimeler:

Anne Sütü, Otizm, Otizm Şiddeti

Duration of Breastfeeding and Its Relationship with Autism Severity in Cases with Autism Spectrum Disorder

Autism Spectrum Disorder (ASD) is a group of neurodevelopmental disorder characterized with social interaction, communication impairments and stereotypic behaviour. Although the aetiology of autism has not yet been fully elucidated, several hypotheses have been proposed to explain the aetiology of autism. Conditions related to breastfeeding, such as duration of breastfeeding, timing have been proposed as environmental risk factors for autism. The aim of this study was to evaluate the relationship between breastfeeding time and autism severity in children with ASD. The study included 88 children with autism who were diagnosed according to DSM-5 diagnostic criteria and 61 healthy age-matched children. Autism severity was assessed by the Childhood Autism Rating Scale (CARS). Demographic data and CARS scores were obtained by scanning the file information. Mean breastfeeding time was 12.97±8.13 months in the ASD group while breastfeeding time was 15.55±7.81 months in the control group. The difference between the groups was not statistically significant (p=0.055). There was a negative correlation between CARS scores and breast milk intake times in the ASD group (p<0.001, r: -0.435). In this study, breastfeeding times in children with ASD were similar to healthy controls. However, the severity of ASD was found to be increased as the duration of breastfeeding decreased in children with ASD. Further studies are needed to clarify the potential pathophysiological role of breastfeeding in the aetiology of ASD and its relationship with disease severity.

Keywords:

Autism, Autism Severity, Breastfeeding,

PDF

___

1. American Psychiatric Association and American Psychiatric Association DSM-5 Task Force. Diagnostic and Statistical Manual of Mental Disorders: DSM-5. Washington, DC: American Psychiatric Association, 2013.
2. Geier DA, Kern JK, Geier MR. The biological basis of autism spectrum disorders: Understanding causation and treatment by clinical geneticists. Acta Neurobiol Exp. 2010; 70:209-26.
3. Herbert MR. Contributions of the environment and environmentally vulnerable physiology to autism spectrum disorders. Curr Opin Neurol. 2010; 23:103-10.
4. Mandy W, Lai MC. Annual research review: The role of the environment in the developmental psychopathology of autism spectrum condition. J Child Psychol Psychiatry. 2016;57(3):271–92.
5. Fujiwara T, Morisaki N, Honda Y, et al. Chemicals, nutrition, and autism spectrum disorder: a minireview. Front Neurosci. 2016;10:174.
6. Lyall K, Schmidt RJ, Hertz-Picciotto I. Maternal lifestyle and environmental risk factors for autism spectrum disorders. Int J Epidemiol. 2014;43(2):443–64.
7. Wang C, Geng H, Liu W, et al. Prenatal, perinatal, and postnatal factors associated with autism: a meta-analysis. Medicine (Baltimore). 2017;96(18):e6696.
8. Williams K, Brignell A, Prior M, et al. Regression in autism spectrum disorders. J Paediatr Child Health. 2015;51(1):61–4.
9. Jones W, Klin A. Attention to eyes is present but in decline in 2–6- month-old infants later diagnosed with autism. Nature. 2013;504(7480): 427–31.
10. Figueiredo B, Canario C, Field T. Breastfeeding is negatively affected by prenatal depression and reduces postpartum depression. Psychol Med. 2014; 44:927–36.
11. Raju TN. Breastfeeding is a dynamic biological process—not simply a meal at the breast. Breastfeed Med. 2011; 6:257–9.
12. Al-Farsi YM, Al-Sharbati MM, Waly MI, et al. Effect of suboptimal breast-feeding on occurrence of autism: a case-control study. Nutrition. 2012;28(7-8):e27–32.
13. Shafai T, Mustafa M, Hild T, et al. The association of early weaning and formula feeding with autism spectrum disorders. Breastfeed Med. 2014;9(5):275–6.
14. Steinman G. Can the chance of having twins be modified by diet? Lancet. 2006;367(9521):1461–2.
15. Boucher O, Julvez J, Guxens M, et al. Association between breastfeeding duration and cognitive development, autistic traits and ADHD symptoms: a multicenter study in Spain. Pediatr Res. 2017;81(3):434–42.
16. Schultz ST, Klonoff-Cohen HS, Wingard DL, et al. Breastfeeding, infant formula supplementation, and Autistic Disorder: the results of a parent survey. Int Breastfeeding J. 2006;1:16.
17. Husk JS, Keim SA. Breastfeeding and autism spectrum disorder in the national survey of children’s health. Epidemiology. 2015;26(4): 451–7.
18. Schopler E, Reichler RJ, DeVellis RF, et al. Toward objective classification of childhood autism: childhood Autism Rating Scale (CARS). J Autism Dev Disord 1980; 10:91-103.
19. İncekaş S. Çocukluk Otizmini Derecelendirme Ölçeği Geçerlik ve Güvenirlik Çalışması. Yayım-lanmamış Uzmanlık Tezi, İzmir, Dokuz Eylül Üniversitesi Tıp Fakültesi Çocuk ve Ergen Ruh Sağlığı ve Hastalıkları ABD, 2009.
20. Krol KM, Grossmann T. Psychological effects of breastfeeding on children and mothers. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2018;61(8):977-85.
21. Krol KM, Rajhans P, Missana M, et al. Duration of exclusive breastfeeding is associated with differences in infants’ brain responses to emotional bodyexpressions. Front BehavNeurosci. 2015; 8:459.
22. Munesue T, Yokoyama S, Nakamura K, et al. Two genetic variants of CD38 in subjects with autism spectrum disorder and controls. Neurosci Res. 2010; 67:181–91.
23. Feldman R, Zagoory-Sharon O, Weisman O, et al. Sensitive parenting is associated with plasma oxytocin and polymorphisms in the OXTR and CD38 genes. Biol Psychiatry. 2012; 72:175–81.
24. Manohar H, Pravallika M, Kandasamy P, et al. Role of exclusive breastfeeding in conferring protection in children at-risk for autism spectrum disorder: results from a sibling case–control study. J Neurosci Rural Pract. 2018; 9(1): 132-6.
25. Bittker SS, Bell KR. Acetaminophen, antibiotics, ear infection, breastfeeding, vitamin D drops, and autism: an epidemiological study. Neuropsychiatr Dis Treat. 2018; 14: 1399-414.
26. James WH. A potential explanation of some established major risk factors for autism. Dev Med Child Neurol. 2012; 54(4):301-5.
27. Hong L, Ziegler J, Brody R. Breastfeeding and autism spectrum disorders. Topics in Clinical Nutrition. 2014; 29(3): 278-85.
28. Bar S, Milanaik R, Adesman A. Long-term neurodevelopmental benefits of breastfeeding. Curr Opin Pediatr. 2016; 28(4): 559-66.
29. Tseng PT, Chen YW, Stubbs B, et al. Maternal breastfeeding and autism spectrum disorder in children: A systematic review and meta-analysis. Nutritional neuroscience. 2017;1-9.
30. Tseng PT, Chen YW, Stubbs B, et al. Maternal breastfeeding and autism spectrum disorder in children: A systematic review and meta-analysis. Nutr Neurosci. 2017:1-9. doi: 10.1080/1028415X.2017.1388598.