**January is National Birth Defects Prevention Month. Each Friday this month, in honor of those babies, we wanted to use this time to share a few stories from local moms who’ve dealt with these trials and tribulations and provide some great resources and information from local Dallas doctors. Although not all birth defects can be prevented, we hope that through raising awareness, steps can be taken to help prevent them.**
Approximately 3 percent of all pregnancies are complicated by a major birth defect. While many of these are unpreventable, there are a few ways that a woman can decrease her risk of having a child with a birth defect prior to conception.
Folic Acid. Simply taking 400 micrograms of folic acid daily through dietary sources or vitamin supplementation will decrease the likelihood of birth defects. Most over the counter multivitamins and prenatal vitamins will have more than 400 micrograms of folic acid. Taking either a multivitamin or a specific folate tablet each day is an effective and affordable way to decrease the likelihood of birth defects.
Smoking. Smoking is associated with an increased risk of abnormally small fetal growth and of preterm birth. Stopping smoking prior to conception or early in the pregnancy can bring the risk of these two problems back down to normal range. At this point, there is no clinical data to support the idea that e-cigarettes or vaping is a better alternative to standard cigarettes.
Alcohol. There is no proven safe level of alcohol intake in pregnancy. The risk of fetal alcohol syndrome increases with increasing levels of alcohol use in pregnancy. Alcohol does cross the placenta and the baby has a decreased ability to metabolize the alcohol, so the alcohol stays in the baby’s system longer.
Weight. Ideal weight is typically considered to be a BMI of 18.5-24 (you can calculate your BMI at http://www.nhlbi.nih.gov/guidelines/obesity/BMI/bmicalc.htm). If your BMI is greater than 24, a weight loss and exercise program can be beneficial prior to trying to get pregnant as obesity has been associated with increased risk of birth defects, preterm delivery, gestational diabetes and preeclampsia. Likewise, it is not better to be underweight, as the baby needs to take nutrients from the mother to grow and develop. Inadequate weight gain in pregnancy can be associated with inadequate growth of the baby and increased risk of preterm birth. A Little Fun Fact–It only takes 400 kcal per baby per day in addition to a normal daily diet to effectively grow a baby. So, “eating for two (or three or four)” is a myth.
Medications. Please make sure you tell your physician about any medications (including herbal medicines and over the counter medicines) that you take. Most medications are safe in pregnancy but some are associated with an increased risk of birth defects. Ideally, anyone with a chronic medical condition or need to take medications should meet with their physician prior to becoming pregnant so that medications can be changed if necessary to avoid any unnecessary risk. However, when you conceive, please do not stop any medications prior to consulting with your physician. It may be unnecessary to stop and suddenly stopping some medications may cause problems.
Diabetes. Women with diabetes are at an increased risk to have children with birth defects. However, this risk is directly related to how poorly controlled the diabetes is. Women with well controlled diabetes have the same risk as women who do not have diabetes. With that said, the level of control that is necessary during pregnancy to achieve this normal risk may be tighter than what most people achieve when they are not pregnant. Diabetic women should ideally meet with their physician to optimize glycemic control prior to conception.
Vaccinations. Many vaccinations (vaccinations that do not contain live viruses) are safe in pregnancy and can be given. Vaccinations that do not contain live viruses do not cause birth defects and certain vaccinations (Influenza and TDaP) are strongly recommended for every pregnant patient during every pregnancy. However, visiting with your physician prior to getting pregnant can give you an opportunity to be up to date on other necessary vaccinations prior to pregnancy.
Infections. Certain infections can cause birth defects. Some of these are cytomegalovirus, varicella and toxoplasmosis.
- Cytomegalovirus is a virus that is commonly spread in urine and, therefore, daycare workers and care takers for young children are at higher risk. The risk is decreased if a person has already had the infection and this can be tested for by a blood test. People taking care of young children or ill adults should use standard gloving and hand washing precautions.
- Toxoplasmosis is rare in the US. Pregnant ladies should avoid cleaning litter boxes while pregnant to avoid exposure.
- Most people have already had varicella (chicken pox) as a child and are not at risk to get it again. If you did not have varicella as a child, getting vaccinated prior to pregnancy and avoiding known exposure are the best means of prevention.
Ethnicity. Certain ethnic groups are at increased risk for some genetic diseases such as sickle cell disease, cystic fibrosis, beta thalassemia and Tay Sachs disease. By meeting with a physician prior to conception, each member of a couple can have a blood test drawn to see if they are at risk for any specific genetic diseases.
Chromosome problems. Chromosome problems such as Trisomy 18 and Trisomy 21 are birth defects that occur at conception. They are not preventable. However, there are many good ways to screen for these now using ultrasound and maternal blood. The two most effective means of screening for these problems are usually done at about 12 weeks by either first trimester aneuploidy screening or cell free fetal DNA. If you are interested in these screens, you should ask your doctor early in the pregnancy in order to not miss the time period in which these screens are performed.
Fortunately, birth defects are relatively rare and most pregnancies are uncomplicated. By critically looking at our health status, the things we put in our bodies and by taking folic acid we can decrease this risk further. Not all birth defects are detectable before birth but many of them are. A thorough ultrasound exam at approximately 18 weeks can detect many birth defects.
Very few such as spina bifida can be fixed prior to delivery. However, awareness of a baby’s birth defect prior to delivery can aid with preparation of the parents and ensuring that the baby is born in the correct hospital with all necessary support available to optimize the baby’s care and transition to the outside world.
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Dr. Brian Rinehart is the director of the Maternal High Risk program at Texas Health Presbyterian Hospital Dallas. He’s a published author and co-author of 27 peer-reviewed medical articles and an obstetric care book. He attended the University of Maryland, School of Medicine in Baltimore, Maryland and completed his internship and residency in Obstetrics and Gynecology at East Carolina University/Pitt County Memorial Hospital in Greenville, North Carolina. Dr. Rinehart completed a fellowship in Maternal Fetal Medicine at the University of Mississippi Medical Center in Jackson, Mississippi. He is board certified in Obstetrics and Gynecology and Maternal-Fetal Medicine.
Dr. Rinehart has been married for over 20 years to his wife, Tracy, and has three children ages 11 to 17. He’s an avid outdoorsman who enjoys the opportunity to hunt and fish when he can find the time.
