Preventing Birth Defects

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Quick Links

• Preconception Care
• Folic Acid
• Chronic Illness
• Alcohol & Drugs
• Tobacco
• Medicines
• Infections
• Other

NEW: Texas Study Links Prepregnancy Obesity and Birth Defects

Although many of the factors that can cause birth defects are not known, scientific research has allowed us to identify many ways in which birth defects can be prevented.

See your health care provider BEFORE you are pregnant.

• CDC Recommendations to Improve Preconception Health and Health Care --- United States
• Issue Brief and Fact Sheet from the Association of State and Territorial Health Officials (ASTHO)

Many birth defects occur in the very early weeks of pregnancy before a woman has missed her first menstrual period, so it is important for women to prevent birth defects even before they conceive. For example: the neural tube must close by about 4 weeks post-conception, so all women who could become pregnant should be taking 400mcg of folic acid every day.

The American Academy of Family Physicians recommends that you "act like you are already pregnant before you try to get pregnant" and that you see your doctor to discuss medical and family history before you conceive.

Other areas of concern to be discussed at a preconception visit include:

• Rubella Immunization
• Toxoplasmosis Screening
• Control of Chronic Diseases like Diabetes and Epilepsy
• Medication Management
• Occupational Risk Assessment
• Substance Abuse Assessment

Click here to see a slide show about Texas women and preconception care. (Microsoft PowerPoint, 750kb, Viewing Information). This issue was also recently featured in the New York Times.

Interconception Care

According to ASTHO, interconception care is "preconception care delivered after a pregnancy that provides a unique opportunity to address specific risk factors that may have contributed to a previous poor pregnancy outcomes". One helpful resource for women who have recently delivered a baby is the brochure produced by the National Birth Defects Prevention Network, "Congratulations, Mom. You Have a Beautiful Baby". This brochure can be downloaded and printed from http://www.nbdpn.org/current/resources/ntd_fa_info.html.

Certain women are at higher risk than others if they have had a baby with a birth defect before. See below for information about neural tube defect recurrence prevention.

Take Folic Acid

Folic acid is a B vitamin used in our bodies to make new cells. If a woman has enough folic acid in her body before she is pregnant, it can help prevent major birth defects of her baby’s brain and spine. These birth defects are called neural tube defects or NTDs. Women need to take folic acid every day starting before they are pregnant to help prevent NTDs.

The U.S. Public Health Service has urged every woman who could become pregnant to get 400 micrograms (400 mcg) of synthetic folic acid every day.

How much is enough? Look for 100%

One easy way a woman can be sure she is getting enough folic acid is to take a vitamin that has folic acid in it every day. Folic acid pills and most multivitamins sold in the U.S. have 100% of the daily value (DV) of folic acid; check the label to be sure. Another way to get enough is to eat a serving of breakfast cereal every day that has been enriched with 100% of the daily value of folic acid. Not every cereal has this amount. Check the label on the side of the box, and look for one that has “100%” next to folic acid.

If You've Had a Baby with an NTD (Recurrence Prevention)

Women who have had a previous NTD-affected pregnancy and are planning a pregnancy, in which case they should consult their physician about consuming 4 milligrams (4,000 micrograms) of folic acid every day for NTD recurrence prevention. That is 10 times the recommended amount for most other women (US Public Health Service). A brochure about NTD recurrence prevention can be found at http://www.nbdpn.org/current/resources/ntd_fa_info.html.

Folic Acid In the News:

• Some corn tortillas to be fortified with folic acid.
• U.S. not meeting folate targets.

Chronic Illnesses

Women who have conditions like diabetes, epilepsy, or obesity should talk to their health care provider about measures to take if they are considering pregnancy, or if they discover that they are pregnant. Sometimes better medication or a different dosage is recommended for treating the condition in pregnancy. Here are some helpful links from the National Institute's of Health's MedlinePlus for more information on chronic illness and pregnancy:

• Diabetes
• Epilepsy
• Lupus
• Other Conditions

What to Avoid

If a pregnant woman can avoid exposure to the following, she can reduce the risk that her baby will be born with birth defects.

Alcohol & Street Drugs

NEW: Alcohol-Exposed Pregnancies: Prevention, Assessment, and Intervention for Women and Children At-Risk Conference on November 12-13th, 2007 at the Omni Southpark Hotel in Austin, Texas. Click here for more information.

No amount of alcohol is known to be safe for the developing fetus. When a pregnant woman drinks, the alcohol in her blood passes through the placenta and reaches the baby—sometimes with devastating consequences. Fetal Alcohol Syndrome (FAS) (98K PDF, Viewing Information) is the leading known preventable cause of mental retardation in the United States. Children with FAS have permanent mental and behavioral problems. They often have distinctly malformed facial features.

In February 2005, the U.S. Surgeon General warned pregnant women and women who may become pregnant to abstain from alcohol consumption in order to eliminate the chance of giving birth to a baby with any of the harmful effects of the Fetal Alcohol Spectrum Disorders (FASD). Health care providers can play an essential role in preventing alcohol-related birth defects. Click here for a summary of methods for screeing for alcohol use during pregnancy (121K PDF, Viewing Information).

Drugs such as cocaine and marijuana, when taken by a pregnant woman, are delivered to the her unborn baby via the blood supply through the umbilical cord. These and most other illegal drugs pass easily to the fetus and therefore must be avoided.

Tobacco

In the U.S., about 1 in 8 women smokes during pregnancy. Smoking may lower the oxygen available to the baby, which can cause the baby to grow more slowly and gain less weight in the womb. But what do we know about smoking and birth defects?

Smoking Raises Risk for Oral Clefts

Oral clefts are birth defects that occur in the oral-facial region often the lip, the roof of the mouth (hard palate), or the soft tissue in the back of the mouth (soft palate). Because of birth defects research, we now know that smokers' babies may be more likely to have cleft lip and/or cleft palate. One study looked at a gene that helps in the development of the palate and mouth. They found that:

• Women who smoked during pregnancy were almost twice as likely to have babies with oral clefts. The more cigarettes the mother smoked, the higher the risk.
• The hazards of smoking were even greater for the 1 in 7 babies who carry a cleft-susceptibility gene. Babies with this gene were 8 times as likely to have oral clefts if their mothers smoked. Those born to nonsmoking mothers with this gene were not more likely to have an oral cleft.
• Nonsmoking mothers who had been around secondhand smoke had only a small, if any, increased risk of having an oral cleft. But if both the mother and father smoked, there was a greater chance that the baby had an oral cleft.

Smoking and Other Birth Defects

• Heart and limb defects . In other birth defects studied, the connection with smoking is not as simple. For example, there was a somewhat higher risk for certain heart defects and limb defects, but only if both parents smoked. Perhaps smoking patterns are different when both parents smoke, or maybe there are other behaviors that are more common among smokers.
• Neural tube defects . Parents' smoking did not increase risk.
• Down syndrome . Babies with Down syndrome whose mothers smoked during the first trimester had twice the risk for heart defects compared to babies with Down syndrome whose mothers did not smoke during pregnancy.

What Can Women Do?

Pregnant women who don't smoke should avoid other people's smoke. Studies suggest that regular exposure to secondhand smoke may harm a developing child. If a woman smokes during pregnancy, she should quit or cut back as much as she can. Here are some resources that can help:

• A health care provider
• National Partnership to Help Pregnant Smokers Quit (http://www.helppregnantsmokersquit.org)
• The American Legacy Foundation (http://www.americanlegacy.org)
• Smokefree.gov (http://www.smokefree.gov)
• AWHONN Nursing Care for Pregnant Women Who Smoke (SUCCESS)

Sources: California Birth Defects Monitoring program (http:// www.cbdmp.org) and March of Dimes Birth Defects Foundation (http:// www.marchofdimes.com)

Medicines

Medicines prescribed by doctors and even the medicines that can be purchased without a prescription can have side effects on a developing fetus or pregnancy. For example, Accutane, a drug commonly prescribed for acne, can cause serious birth defects of the head, brain and face if taken early in pregnancy. Some antiseizure drugs can have adverse effects on the baby. All women should talk to their doctor before taking medicine during pregnancy.

Resources:

• December 2005 FDA warning about paroxetine (Paxil)
• FDA Guide to Pregnancy Registries

Infectious Agents

Germs that cause only mild or no symptoms at all in adults can be deadly to the unborn fetus. Women of childbearing age can avoid some of these by making sure that all of their immunizations are up-to-date before becoming pregnant. Other harmful germs and parasites can be avoided by using good hygiene. The parasite that causes toxoplasmosis, for example, is found in cat feces and raw meat, and can cause severe brain damage in the fetus. Pregnant women should avoid contact with raw meat, sand or litter boxes, and wear gloves when gardening.

Lymphocytic choriomeningitis virus (LCMV)

LCMV is carried by wild mice. Laboratory rodents and pet rodents, such as hamsters and guinea pigs, can become infected with LCMV from contact with wild mice. This can happen in a breeding facility, in a laboratory facility, in a pet store, or in the home (e.g., if wild mice are present). If you have an LCMV infection during your pregnancy, your unborn baby can also become infected. LCMV infection during pregnancy can result in loss of the pregnancy. Infants who are infected with LCMV before they are born can have severe birth defects. It is not known how often this happens because pregnant women with LCMV infection might have only mild symptoms or no symptoms at all, and babies often are not tested for the infection. Since LCMV infection was first identified, more than 50 babies have been reported with LCMV infection worldwide.

Find out more here.

Rubella

Until the early 1970s, thousands of children suffered birth defects and death after their mothers became infected with rubella, or German measles, but there were have been less than three cases of congenital rubella syndrome per year in the United States since 2001. Although the Centers for Disease Control and Prevention has determined that is no longer a serious health threat in the United States, experts say the vaccine is safe and effective, and the benefit of having it outweighs the limited risk of exposure to the disease.

Find out more here.

Other Hazardous Substances

Because most substances can pass through the placenta into the fetus' blood supply, mothers-to-be should avoid exposure to anything toxic. This includes fumes from strong household chemicals such as gasoline, paints, paint thinner, and pesticides; lead in some paints; and water from contaminated sources. You can look up health and safety information on common household products at the National Library of Medicine's Household Products Database, and you can call the Texas Teratogen Information Service at (800) 733-4727.

Find Out More:

External links to other sites are intended to be informational and do not have the endorsement of the Texas Department of State Health Services. These sites may also not be accessible to people with disabilities.

• From the CDC: Preventing Infections During Pregnancy
• CDC's 5 Steps to Get ready for a Healthy Pregnancy
• Folic Acid Consumption among Texas Women (BRFSS, 2003-2005, Select "Women's Health: Folic Acid)
• National Council on Folic Acid
• Medication Use During Pregnancy and Breastfeeding (Centers for Disease Control and Prevention)
• Organization of Teratogen Information Services Fact Sheets
• Smoking and Birth Defects (California Birth Defects Monitoring Program)
• National Organization on Fetal Alcohol Syndrome
• U.S. Food & Drug Administration (FDA) Pregnancy Registries
• What You Need to Know About Mercury in Fish and Shellfish (FDA)
• Thalidomide: Important Patient Information FDA
• Toxoplasmosis: An Important Message for Women (242K PDF, Viewing Information)
• American Diabetes Association: Before Pregnancy
• Elimination in Public Health: Elimination of Rubella and Congenital Rubella Syndrome (MMWR)
• X-Rays, Pregnancy and You (FDA)

Last Updated August 7, 2007.