Experts call for further research as study finds modestly increased autism risk in areas with higher lithium levels in drinking water
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A recently conducted study has found a moderately higher risk of autism spectrum disorder (ASD) in children born to pregnant people who were exposed to tap water with higher levels of lithium. However, experts caution that this association does not indicate a direct link between the two.
Autism spectrum disorder affects approximately 1 in 36 children in the US each year, according to data from the US Centers for Disease Control and Prevention. While the exact cause of autism is still unknown, researchers have been exploring potential environmental causes in addition to genetics.
The number of autism cases may be on the rise, but it’s unclear due to various factors. One study conducted in the New York-New Jersey area revealed a tripling of autism diagnosis rates among certain age groups between 2000 and 2016. Another report in 2021 also found similar increases. However, the CDC suggests that the increased number of cases is likely due to more doctors screening individuals for the condition.
Lithium, an alkali metal found naturally in some food and groundwater, is used in various applications such as batteries, grease, air conditioners, and even for bipolar disorder treatment. In the US, the levels of lithium in drinking water are not regulated. A recent study published in JAMA Pediatrics examined the association between lithium levels in drinking water in Denmark, where the researchers claim the levels are similar to those in American water systems.
The study analyzed a database of people with psychiatric disorders and collected information on 8,842 cases of ASD and 43,864 participants without ASD who were born between 2000 and 2013. The researchers measured the concentration of lithium in 151 public waterworks serving more than half of the Danish population and mapped out the locations of pregnant individuals in relation to these waterworks.
The findings revealed a modest increased risk of ASD diagnosis as lithium levels in water increased. Compared to individuals with the lowest exposure level, those with the second and third highest exposure during pregnancy had a 24% to 26% higher risk of ASD diagnosed in their children. The group with the highest exposure had a 46% higher risk compared to those with the lowest exposure level.
It’s important to note that the study cannot establish a direct causal relationship between lithium exposure and autism diagnosis. Further research is needed to replicate these findings in other countries and explore similar connections.
The implications of these findings are complex, as they raise questions regarding public health policy. Lithium levels in water, at concentrations associated with potential ASD risk, have also been linked to health benefits such as lower rates of hospitalization for psychiatric disorders and suicide.
Considering this complexity, guidelines for lithium in drinking water that optimally protect the entire population will require careful consideration. Until the underlying biology of ASD is better understood, it will be challenging to distinguish causal associations from spurious ones.
Dr. Max Wiznitzer, director of the Rainbow Autism Center at University Hospitals Rainbow Babies and Children’s Hospital in Cleveland, highlights the importance of exploring viable and biologically plausible mechanisms behind the potential impact of lithium in the water supply. Studies on pregnant individuals exposed to higher levels of lithium through medication for mental health disorders have not shown a connection to autism spectrum disorder.
Other studies have also suggested links between ASD and environmental exposures, such as pesticides, air pollution, and phthalates. However, none of these factors has been proven to be a direct cause of the disorder.
Establishing a definitive link between environmental exposures and ASD is challenging. For example, while research indicates that increased exposure to air pollution raises the risk of giving birth to a child with ASD, it remains unclear whether pollution itself is the determining factor or if it’s the populations residing in more polluted areas.
Amidst various environmental stressors in our everyday lives, it’s crucial to navigate them safely. While the association between lithium exposure and autism remains an interesting area of study, it may not be at the forefront of our concerns for now.