Parents and parents-to-be can often be on the receiving end of "expert" advice that is confusing, if not downright contradictory. And when scientific researchers take on parenting stuff, things get particularly, shall we say, puzzling.
This week, two new studies are raising concerns about really common practices: Taking folic acid during pregnancy, and swaddling new babies. Here's what moms and dads need to know:
Study 1: Too Much Folic Acid During Pregnancy Increases Risk For Autism
The background: Getting sufficient folate, or folic acid as it's known in synthetic form, is an essential part of a healthy pregnancy. Top medical groups recommend that pregnant women take a supplement with at least 400 micrograms of folic acid daily in order to help prevent neural tube defects -- birth defects of the brain, spine or spinal cord. The benefits are indisputable. Studies have shown that more than half of these birth defects can be prevented by getting enough folic acid, which can be as simple as remembering to pop a daily prenatal vitamin.
The study: Researchers with Johns Hopkins' Wendy Klag Center for Autism and Developmental Disabilities analyzed data from nearly 1,400 Boston-area moms and their babies who were recruited between 1998 and 2013 and followed for several years. Soon after the women gave birth, researchers checked their blood folate levels, and were surprised to find that one in 10 had what was considered to be an excessive amount (more than 59 nanomoles per liter, if you want specifics). It's unclear why those women had too much folate in their blood. Some may have eaten too many folic-acid-fortified foods (flours, cereals, and other enriched grain products are often fortified with folic acid, and folate occurs naturally in foods like spinach, asparagus and lentils). Others may have taken too many prenatal supplements. It's also possible that some women's bodies simply metabolize folate differently.
"Right now, we do not know which of these, or which combinations, have led to these very high levels," said study researcher Ramkripa Raghavan, a doctor of public health candidate in the department of population, family and reproductive Health at the Johns Hopkins Bloomberg School of Public Health. "More work is needed so that we can make informed recommendations for obstetricians and mothers."
But whatever the reason, the researchers found a link between excessive folate and autism. Children born to moms with very high levels had double the risk of developing autism compared to those whose mothers had normal folate levels. The researchers also found that very high levels of vitamin b12 tripled the risk of developing autism.
"Biologically, we know that folate and vitamin B12 are together involved in variety of metabolic processes critical to maternal and child health," said Raghavan. "It is plausible that both too little, and too much, could be problematic given the essential roles folate and B12 play."
What parents need to know: First thing's first: The study is preliminary. It's being presented at the International Meeting for Autism Research this week, but it hasn't been published in a peer-reviewed journal, which means it hasn't been subject to that level of scientific scrutiny. The Huffington Post reached out to the March Of Dimes, an organization dedicated to improving the health of babies and a huge proponent of folic acid supplementation, and the group declined to comment, saying it would wait for a peer-reviewed paper, if one was published.
The study's researchers have been very clear they're not arguing against folic acid. In fact, they found that moms-to-be who took prenatal supplements three to five times a week may have reduced their child's risk of developing autism -- and other studies have shown the same. What they're highlighting is the possibility that excessive folate is dangerous.
Frustratingly, they don't have a lot of information about what a safe upper limit might be, so it's kind of a Goldilocks-style guessing game at this point. "Researchers are working on understanding optimum levels for fetal health and how to achieve those levels so that these findings can be communicated effectively to families and doctors," Raghavan said. For now, talk to your doctor and don't necessarily assume that more = better.
Study 2: Does swaddling increase a baby's risk of SIDS?
The background: Swaddling is an ancient practice that has become super popular again, partly in response to the massive Back to Sleep (now "Safe to Sleep") campaign of the 1990s, when doctors and public health officials began urging parents to put their babies on their backs to sleep to help reduce infant deaths from SIDS. It definitely helped, but it also left a lot of parents scrambling for solutions for squirmy infants who hate snoozing on their backs. Swaddling, according to proponents like Harvey Karp, can seriously help with new babies' startle reflex by mimicking the close, secure environment of the womb, and may even allow them (and parents) to get some sleep in those long, hard early days, weeks and months.
The study: Researchers conducted a review of four previous studies that looked at a possible link between swaddling and SIDS risk. There were some significant limitations to the data. The studies took place across two decades, for example, and in several different countries. And none of the studies gave a precise definition as to what counted as swaddling. With what kind of blanket? How tight? Those details weren't included.
Overall, the authors of the new review, which was published in the journal Pediatrics this week, found a very slight increase in the risk of SIDS among babies who were swaddled and placed on their backs. However, it was nearly double in babies who were placed on their sides. It was also double in those who were placed or found on their stomachs. The risk seemed to increase in older babies, with the highest risk among those age six months or older.
What parents need to know: Really, none of this is likely to be particularly shocking to care providers or to parents. Safe sleep guidelines make it very clear that infants should be placed on their backs to go to sleep, never on their sides or stomachs -- whether they're swaddled or not. And though groups like the AAP don't have clear recommendations for swaddling, doctors generally advise that parents stop swaddling their babies as soon as they can roll over.
"If you're going to swaddle them, put them on their back," said Dr. David Mendez, neonatologist at Nicklaus Children's Hospital in Miami who didn't work on the new study, but had reviewed it. "Once they get big enough when they can roll back and forth, it isn't going to help them much anyway. Learning to calm oneself is one of those milestones babies have to do."
The new study simply points out some concerns, Mendez added, and there's clearly more research that needs to be done -- even to just come up with a specific agreement for what swaddling actually means.
But for now, there's no need for exhausted parents to panic. Talk to a trusted health care provider if you have any questions or concerns about swaddling and how to do it safely, or whether it makes sense for your baby.
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