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Many Birth Defects Can Be Prevented

Taking folic acid, avoiding alcohol can reduce risks, experts say

THURSDAY, Jan. 20, 2005 (HealthDayNews) -- No matter how deeply a mother cares for her unborn child, there's no guarantee her baby will be born in perfect health. Birth defects are more common than you might think, and they're not always avoidable.

One in 33 infants in the United States is born with a birth defect, according to the National Birth Defects Prevention Network (NBDPN). Although genetic factors play a role, the causes of most birth defects remain a mystery, the group says.

But there are simple steps a woman can take to boost the odds of bearing a healthy child. That's the message the NBDPN wants women, their partners and health-care providers to heed this January, designated as National Birth Defects Prevention Month.

"What we try to do is educate women about having a healthy pregnancy to prevent any type of birth defect," said Denise Higgins, chairwoman of the group's education and outreach committee.

For example, women are advised to take folic acid at least a month before planning to become pregnant. Folic acid, or folate, is a B vitamin necessary for proper cell growth. Studies show it can decrease the risk for neural tube birth defects, including spina bifida, a leading cause of childhood paralysis, and anencephaly, a fatal condition in which parts of the brain and skull cap are missing.

About 2,200 babies are born with neural tube defects each year in the United States, according to the March of Dimes.

It's important to get enough folic acid before becoming pregnant because the neural tube -- the part of the embryo that becomes the brain and spinal cord -- develops in the first couple weeks of pregnancy. Forty percent of American women of childbearing age now get enough of the vitamin to help prevent birth defects, according to a 2004 March of Dimes survey. That's up from 32 percent the previous year -- a sharp increase, but far from the majority.

On Jan. 24, the National Council on Folic Acid is launching National Folic Acid Awareness Week to make people aware of the many benefits of this vitamin.

The U.S. Public Health Service urges all women of childbearing age to take a multivitamin containing 400 micrograms of folic acid every day. Folic acid pills and most multivitamins sold in the United States have 100 percent of the daily value of folic acid, according to the U.S. Centers for Disease Control and Prevention, but women should read the label to be certain.

Women who have previously had a child with a neural tube defect need even more folate: 4 milligrams daily before conceiving and during the pregnancy is recommended, says Dr. Diane Ashton, associate medical director of the March of Dimes.

Women also are advised to abstain from drinking alcohol at any time during their pregnancy. Alcohol can cause fetal alcohol syndrome (FAS), a lifelong condition characterized by abnormal facial features, growth retardation and central nervous system problems. Children with FAS may have physical, mental, social and behavioral problems.

As many as one in 1,000 children born in the United States each year suffers from fetal alcohol syndrome, the NBDPN says. And prenatal alcohol-related conditions, including alcohol-related neurodevelopmental disorder and alcohol-related birth defects, are believed to occur three times as often as fetal alcohol syndrome, the CDC notes.

"There's no healthy amount of alcohol a woman can drink," Higgins cautioned. "We don't know if one drink causes fetal alcohol syndrome or being an alcoholic does, so the message is, 'Don't drink.'"

Studies show even "social drinking" -- a drink or two a week -- may have adverse effects on the fetus, Ashton said. Yet many women are not getting the message. "And it's really important for their health-care provider to be able to convey that information to them," she said.

If you are pregnant, you will most likely have a simple blood test called an alpha fetoprotein (AFP) test to screen for fetal abnormalities, including spina bifida and anencephaly. More invasive testing, including chorionic villus sampling and amniocentesis, is generally reserved for women 35 and older, or whose AFP results suggest a higher risk for birth defects.

Whether women under 35 should request invasive testing depends entirely on their preferences, said Miriam Kuppermann, an associate professor in the Department of Obstetrics, Gynecology and Reproductive Sciences at the University of California, San Francisco, who has studied the cost effectiveness of invasive testing.

"If they are interested, they should request clear information on the likelihood that they are carrying an affected fetus and the miscarriage risk of the procedure, as well as on other testing options," she said. Women who desire such testing should get an appointment with a genetic counselor to review the risks and benefits.

If you're planning to become pregnant, talk to your doctor about any health concerns you have. Women with diabetes and epilepsy, for example, are at greater risk of having a baby with a neural tube defect, Ashton said.

Also, ask your doctor about any medications you are taking. Certain acne and seizure medicines have been linked to birth defects, Higgins explained.

No one should have to suffer the heartache of having a child with a serious birth defect, so prenatal care experts encourage women to discuss any concerns they have with their health-care provider ahead of time.

"Preconception counseling is very important," Ashton said.

More information

The U.S. Centers for Disease Control and Prevention has more about preventing birth defects.

SOURCES: Denise Higgins, chairwoman, education and outreach committee, National Birth Defects Prevention Network, Helena, Mont.; Diane Ashton, M.D. M.P.H., associate medical director, March of Dimes, White Plains, N.Y., Miriam Kuppermann, Ph.D., M.P.H., associate professor, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco
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