Recently, there has been a noticeable increase in the number of children diagnosed with attention deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD).
Pregnant women in SA, in the main, received their supplements from public health clinics, ensuring their intake was regulated and advised by healthcare professionals.
However, with changes in socioeconomic conditions, increased access to medical aid and the ability to purchase supplements directly from pharmacies, the dynamics have shifted.
These supplements are formulated to include essential nutrients such as folic acid, iron, and calcium, which are critical components for fetal development.
The controlled dissemination of these supplements ensured that pregnant women received adequate nutrients without over-consumption, balancing the risks of deficiencies and excesses.
Folic acid, for instance, reduces the risk of serious birth defects, called neural tube defects, such as spina bifida and anencephaly, which can be fatal or cause lifelong disability.
Beyond preventing structural anomalies, folic acid also supports maternal red blood cell production and helps prevent megaloblastic anemia, a condition that compromises oxygen delivery to both mother and fetus.
Iron supplements support increased blood volume and oxygen transport, which are critical during pregnancy.
As maternal blood volume expands to support the growing fetus and placenta, iron becomes essential for producing sufficient red blood cells and maintaining effective oxygen transport.
Adequate iron is linked to fetal brain development and improved pregnancy outcomes, making deficiency a developmental risk factor.
Calcium supplements support fetal bone development.
Adequate calcium has been shown to significantly reduce the risk of pregnancy-induced hypertension and preeclampsia, which are two of the most dangerous complications contributing to maternal and perinatal mortality.
Back to the rationale behind me penning these thoughts, noting the socioeconomic conditions in SA that have evolved considerably over the years, with a growing middle class and an increase in disposable income among certain demographics.
Many expecting mothers now have the means to purchase supplements from pharmacies.
While this autonomy can be empowering, it also raises potential concerns about unmonitored supplement intake without professional medical guidance.
Some women may consume inappropriate dosages without understanding their specific nutritional needs during pregnancy.
Unsupervised consumption could contribute to the surge in ADHD and autism diagnoses if certain nutrients are taken excessively or deficiently.
I must however, make a disclaimer that I have not conducted any research or explored any researched findings on this, but believe it may contribute based on my little understanding of ADHD and autism.
ADHD is said to be primarily characterised by symptoms of inattention, hyperactivity, and impulsivity.
People with ADHD may struggle with organising tasks, maintaining focus or controlling impulsive behaviours, which can impede their academic, occupational, and social functioning.
The exact cause of ADHD is not fully understood but it is believed to be linked to genetic, neurobiological, and environmental factors.
ASD is a condition related to brain development, affecting how people see others and socialise with them.
This causes problems in communication and getting along with others socially.
The etiology of ASD is believed to be a combination of genetic and environmental influences.
Historically, there has been a lack of awareness and understanding about these disorders, often resulting in underdiagnosis and stigmatisation.
Rural traditional beliefs and limited medical resources may hinder access to diagnosis and care.
Stigma and misconceptions about neurodevelopmental disorders might lead to children being mislabeled as ‘naughty’ or ‘ill-disciplined,’ especially in educational settings, complicating early intervention efforts.
I also believe, however, that a significant component in understanding the rise in diagnoses is the changing landscape of inequality, socioeconomic status, and education.
Inequality persists in many forms, affecting access to quality healthcare and education.
Higher socioeconomic status grants certain privileges, such as medical aids, which enable people to access private healthcare and buy supplements without prescriptions, which I believe may lead to disparities in maternal nutrition and consequently child development.
Also, lower socioeconomic groups relying on public healthcare may still lack comprehensive nutritional information and access to necessary supplements due to challenges such as not being aware of the importance of attending antenatal care.
Therefore, several policy and educational interventions could be beneficial to address the evolving supplement landscape.
The National Health Insurance (NHI), which aims to provide universal healthcare coverage, I believe can address the challenges associated with unmonitored supplement intake.
The NHI could possibly introduce strict regulations and systems to ensure prenatal supplements are only dispersed following professional healthcare guidance. This is my wish and belief.
NHI access to healthcare services would be equitable and standardised, regardless of an individual’s socioeconomic status.
In the meantime, government may need to introduce policies regulating the sale of prenatal supplements to ensure expecting mothers purchase supplements following a prescription, and most importantly, increase awareness on the importance of proper antenatal care and the risks of uncontrolled supplement intake through public health campaigns.
Initiatives aimed at educating the public about ASD and ADHD can help reduce stigma and promote understanding.
I must, however, emphasise that antenatal care in primary healthcare settings plays a critical role in this context, as it serves as a critical point of contact where expectant mothers can receive education and support grounded in scientific understanding.
It must be noted that comprehensive antenatal care ensures that health professionals monitor the health of both the mother and the fetus, allowing for early intervention if necessary.
The dedication of antenatal care nurses in public clinics deserve recognition and appreciation.
These frontline healthcare workers often operate under challenging conditions yet their role is indispensable in ensuring the health and wellbeing of both mother and child.
While genetic and environmental factors are believed to contribute to these conditions, the exact causes are not fully understood as per research, therefore investigating prenatal influences such as supplement intake, becomes important as we seek to understand these disorders better.
Zinzi Rabe, former Eastern Cape ANC PEC member and former MPL
Daily Dispatch
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