Autism prevention can begin before birth, according to an Italian study.

Many cases of autism spectrum disorder (ASD) may arise from maternal immune interference with fetal brain development, according to a groundbreaking Italian study on autism published in Clinical and Translational Neuroscience.

This study, which the authors say is "rewriting the rules in understanding and preventing autism," reveals "a crucial link between folate deficiency in the fetal brain and the presence of specific antibodies called FRAAs (anti-folate receptor alpha antibodies) in the mother's blood ." The discovery—authored by Claudio Giorlandino, scientific director of the Altamedica Research Institute and lead author of the study along with Katia Margiotti, Marco Fabiani, and Alvaro Mesoraca—opens up "very interesting avenues" for prevention, according to the researchers.

"We now know that one of the main causes of non-genetic autism," explains Giorlandino, "is a lack of folate in the child's brain during pregnancy. This is often caused by specific antibodies present in the mother's blood, called FRAAs. Think of folate (vitamin B9) as the essential nutrient for the development of the child's nervous system, crucial for building DNA and the growth of brain cells."

Normally, the mother transfers this precious folate to the fetus through the placenta. The problem arises when the FRAA antibodies block a sort of gate (the receptor) that allows folate to enter the baby's brain . This creates a true folate deficiency in the fetal brain, even if the mother has enough in her blood. If this deficiency occurs in the early stages of pregnancy, it can contribute to the onset of autism spectrum disorders or, in milder forms, specific learning disabilities (SLD). The condition, well known for years, is called Cerebral Folate Deficiency.

International literature—a statement recalls—has already reported that over 70% of children with autism exhibit at least one type of FRAA antibody. These antibodies are often found in close family members, suggesting a predisposition. Since maternal antibodies can reach the fetus as early as the first months of pregnancy, their presence can directly interfere with proper brain development.

What can change now

The good news is that the new study opens the way to timely intervention . A simple blood test for the mother has been developed that can detect the presence of these antibodies, experts explain. If the test is positive, treatment can be done with a special type of folate, folinic acid (calcium folinate), which has the ability to bypass the "gateway" blocked by the antibodies, reaching the fetus' brain through other routes. It can be taken both before and during pregnancy to compensate for the deficiency, but it is necessary to ensure that the FRAA test demonstrates the presence of these antibodies in the mother. The higher their presence, the greater the damage.

"If we identify these antibodies early," Giorlandino remarks, "we can intervene already during pregnancy with preventive therapy. If we wait, the damage is done, and although many recent pediatric studies, including randomized, controlled trials, have documented a marked improvement with postpartum therapy, unfortunately the damage has already been done and full recovery is impossible. This is a momentous turning point," he states, " in the prevention of autism spectrum disorders, which are much more common than other conditions for which routine screening is done , such as Down syndrome or infections during pregnancy."

The study hypothesizes that the rise in autoimmune diseases in women—influenced by factors such as pollution, diet, cosmetics, and lifestyle—may explain the increase in FRAA cases and, consequently, neurodevelopmental disorders in children. This research, the authors conclude, "is not only a scientific advance, but a fundamental step toward a future in which autism prevention could become a concrete reality."