1. The Link between Oral Contraceptives Use and Increased Prevalence in Autism Spectrum Disorder Presentation by: Kim Strifert

2. The Link between Oral Contraceptive Use and Increased Prevalence in Autism Spectrum Disorder My Observation

3. The Link between Oral Contraceptive Use and Increased Prevalence in Autism Spectrum Disorder Complex neurodevelopmental disorder Social impairments, communication difficulties, and restricted, repetitive, and stereotyped patterns of behavior. 1-68 children Increased prevalence

4. The Link between Oral Contraceptive Use and Increased Prevalence in Autism Spectrum Disorder

5. The Link between Oral Contraceptive use and Increased Prevalence in Autism Spectrum Disorder Identification, screening, diagnostic criteria, awareness Genetic variation Environment

6. The Link between Oral Contraceptive Use and Increased Prevalence in Autism Spectrum Disorder Preterm birth weight, low birth weight Multiple birth, breech presentation, cesarean delivery Assisted reproductive technology Parental age Socioeconomic inequalities Parental exposure to occupational chemicals, pesticides Living close to freeways Folic acid MMR vaccine, Thimerosal Acetaminophen, excessive multivitamins Dietary factors

7. The Link between Oral Contraceptive Use and Increased Prevalence in Autism Spectrum Disorder

10. Method No. of users (in 1000s) % of all women 15- 44 % of all contraceptive users Pill (COC’s10,54017.127.5 Tubal Ligation10,20016.526.6 Male Condom6,28010.216.3 Vasectomy3,860 6.210.0 IUD2,140 3.5 5.6 Withdrawal1,990 3.2 5.2 Injectable1,450 2.4 3.8 Vaginal Ring830 1.3 2.2 Patch290 0.5 0.7 Implant180 0.3 0.5 Fert. Awareness440 0.7 1.1 Other Methods**200 0.3 0.5 No Method23,36037.8 Total # women 15-4461,750100.0 Sexually active women who have ever used COC’s*** 50,63582 Adapted from Guttmacher Organization, Mosher and Jones (2010) Vital Health Statistics

11. The Link between Oral Contraceptive Use and Increased Prevalence in Autism Spectrum Disorder How do oral contraceptives work? Progestins suppress ovulation, the release of the egg, and thicken the mucus of the cervix. Estrogen augments the action of the progestogenic compound and stabilizes the endometrium.

12. The Link between Oral Contraceptive Use and Increased Prevalence in Autism Spectrum Disorder

13. Progestogen negative feedback reduces the pulse frequency of GnRH release by the hypothalamus which decreases the secretion of follicle-stimulating hormone (FSH) and significantly decreases the secretion of luteninzing hormone (LH) by the anterior pituitary. Diminished levels of FSH inhibit follicular development and prevent an increase in circulating blood levels of estradiol. Progestogen negative feedback and the absence of estrogen positive feedback on LH secretion inhibit LH surge in mid-cycle. Inhibition of follicle development and lack of LH surge prevents ovulation.

14. The Link between Oral Contraceptive Use and Increased Prevalence in Autism Spectrum Disorder Ethinylestradiol is an Endocrine Disrupting Compound (EDC )

15. The Link between Oral Contraceptive Use and Increased Prevalence in Autism Spectrum Disorder EDCs have the same attributes as hormones: Ability to be active at low concentrations Ability to bind to receptors at very low concentrations Ability to interact with multiple hormone receptors concurrently Work simultaneously to create additive or synergistic effects not observed with individual compounds Often not feasible to extrapolate low-dose effects from high-dose effects of EDCs

16. The Link between Oral Contraceptive Use and Increased Prevalence in Autism Spectrum Disorder World Health Organization State of the Science of Endocrine Disrupting Compounds 2012

17. The Link between Oral Contraceptive Use and Increased Prevalence in Autism Spectrum Disorder Exposure Timing Before Fertilization After Fertilization Transgenerational transmission of modified epigenetic programming

18. The Link between Oral Contraceptive Use and Increased Prevalence in Autism Spectrum Disorder Oral Contraceptives are Marketed as Safe and Effective But Are They ?

19. The Link between Oral Contraceptive Use and Increased Prevalence in Autism Spectrum Disorder

20. Lack of Comprehensive Research into Potential Neurodevelopmental effects of Contraceptives

21. The Link between Oral Contraceptive Use and Increased Prevalence in Autism Spectrum Disorder Temporal correlation between use of oral contraceptives and increased prevalence of ASD. To date no definitive cause or contributing factors for increase in ASD prevalence has been established. Oral contraceptives disrupt the endocrine system – COC’s are endocrine disruptors. Oral contraceptives directly and deleteriously affect both the ovaries and ova. Likely effects of oral contraceptives on progeny are an open question. The called-for further study and controlled follow-up of the possible transgenerational effects of oral contraceptive use has not been executed.

22. The Link between Oral Contraceptive Use and Increased Prevalence in Autism Spectrum Disorder Multi-Hit Model of Autism Risk Combined Oral Contra- ceptives Genetics Environment Epigenetics ? Other Factors ASD

23. The Link between Oral Contraceptive Use and Increased Prevalence in Autism Spectrum Disorder