Prenatal exposure of a girl with autism spectrum disorder to 'horsetail' (Equisetum arvense) herbal remedy and alcohol: a case report

Abstract

IntroductionAutism is a complex neurodevelopmental disorder in which the interactions of genetic, epigenetic and environmental influences are thought to play a causal role. In humans, throughout embryonic and fetal life, brain development is exquisitely susceptible to injury caused by exposure to toxic chemicals present in the environment. Although the use of herbal supplements during pregnancy is relatively common, little information is available on their association with fetal neurodevelopment. This is, to the best of our knowledge, the first report in the literature to associate a new plausible mechanism of neurodevelopmental toxicity with a case of autism spectrum disorder through a vitamin deficiency potentiated by concomitant use of herbal supplements and ethanol exposure.Case presentationWe describe the pediatric environmental history of a three-year-old Caucasian girl with an autism spectrum disorder. We utilized her pediatric environmental history to evaluate constitutional, genetic, and environmental factors pertinent to manifestation of neurodevelopment disorders. Both parents reported prenatal exposure to several risk factors of interest. A year prior to conception the mother began a weight loss diet and ingested 1200 mg/day of 'horsetail' (Equisetum arvense) herbal remedies containing thiaminase, an enzyme that with long-term use can lead to vitamin deficiency. The mother reported a significant weight loss during the pregnancy and a deficiency of B-complex vitamins. Thiamine (vitamin B1) deficiency could have been potentiated by the horsetail's thiaminase activity and ethanol exposure during pregnancy. No other risk factors were identified.ConclusionsA detailed and careful pediatric environmental history, which includes daily intake, herbal remedies and ethanol exposure, should be obtained from all patients with autism spectrum disorder. Maternal consumption of ethanol and of herbal supplements with suspected or potential toxicity should be avoided during pregnancy. The prospective parents should perform preconception planning before pregnancy.

Neurological, Psychiatric, and Biochemical Aspects of Thiamine Deficiency in Children and Adults

“…Limited findings are available on the link between thiamine bioavailability and the development of autism. However, studies show that the consumption of herbal supplements rich in thiaminase during pregnancy (132) or alcohol exposure in utero (133) may predispose a fetus to thiamine deficiency during pregnancy and increased risk for ASD. A study conducted on rat pups nursed by thiamine-deficient dams displayed comparable findings, in which the offspring exhibited behavioral abnormalities consistent with ASD symptoms (134).…”

Herbal Products in Pregnancy: Experimental Studies and Clinical Reports

“…Although the use of herbal supplements during pregnancy is relatively common, little information is available for example on their association with fetal neurodevelopment. Ortega García and coworkers () have published the first report in the literature about the association of a new plausible mechanism of neurodevelopmental toxicity with a case of autism spectrum disorder in association with HMP and alcohol exposure. The authors state that this event is associated with vitamin deficiency of the mother due to the ingestion, a year prior to conception to obtain a rapid weight loss, of 1200 mg/day of ‘horsetail’ containing thiaminase in association with ethanol exposure.…”

“…The authors state that this event is associated with vitamin deficiency of the mother due to the ingestion, a year prior to conception to obtain a rapid weight loss, of 1200 mg/day of ‘horsetail’ containing thiaminase in association with ethanol exposure. This case report has several limitations such as the lack of clear information on all herbal preparations taken, possible interaction between multiple exposures and the lack of biomarkers in the study; this work, however, serves to highlight the potential risks associated with the assumption of alcohol and herbal remedies with suspected or potential toxicity (Ortega García et al ., ).…”

Exposición periconcepcional a factores ambientales y de consumo en padres y cuidadores de niños menores de 5 años en Santander

“…El embarazo, la lactancia y el periodo periconcepcional (abarca los tres meses previos a la fecundación) son etapas vulnerables a agentes medioambientales, en las cuales, la salud materno-infantil puede afectarse por la exposición activa o pasiva a diferentes factores (8)(9)(10)(11)(12)(13). Durante estas etapas, las sustancias psicoactivas legales e ilegales constituyen una de las exposiciones a tóxicos medioambientales, con efectos severos en el desarrollo infantojuvenil potencialmente prevenibles en el 100% de los casos (10,14), por lo cual, en una perspectiva medioambiental global, las drogas tiene un rol relevante en la salud del binomio madre-hijo.…”