January has been designated by the March of Dimes as birth defect awareness month: a time for nurses to share greater knowledge with those around us about the preventable causes of birth defects.

One in every 33 babies will be born with some sort of birth defect.  A birth defect is identified as any deviation from the normal growth patterns of a developing baby within the mother’s womb.  Birth defects can be related to genetics or environmental problems occurring during the pregnancy.  Most of these problems occur within the first three months of the pregnancy and are identified during the first year of life.  About one-third of these anomalies will be related to the heart.  Other common problems are related to neural tube or cleft defects.

Perhaps the most crucial time for women of childbearing age to consider their lifestyle habits is prior to conception.  Medication use, alcohol, smoking and other substances are of particularly high concern because approximately half of all pregnancies in the United States are unintentional, or unplanned for.  Many women will continue to consume substances that can be harmful for fetal development before realizing they have become pregnant.

The optimal solution to reduce the risk of some birth defects is an assessment of any medications (especially isotretinoins, antiepileptics, anticoagulants and thyroid supplements) prior to pregnancy.  Each patient should also be counseled that alcohol, smoking, and illicit drugs should be abandoned and the intake of folic acid should be increased to 400mcg every day prior to conception.

The use of folic acid before and during the pregnancy reduces the risks of the fetus developing neural tube defects, heart defects and cleft palates.  Though there have been recent arguments made that folic acid use results in increases in the number of multiple pregnancies and miscarriages, these concerns have yet to be proven substantial through scientific studies.  Therefore, nurses should continue to encourage their prenatal patients to get the recommended amount of folic acid before and during their pregnancy.

Alcohol use and marijuana increase the risks of ventricular septal defects (VSD), which is the most common type of heart malformation.  Exposure to alcohol can also cause a range of birth defects covered under the umbrella term fetal alcohol spectrum disorders (FASDs).  Within this spectrum is the well known fetal alcohol syndrome identified as one of the leading preventable causes of mental retardation and birth defects.  Other difficulties resulting from prenatal alcohol exposure include: functional, behavioral and cognitive abnormalities and congenital problems with the kidneys, bones or hearing as well as heart malformations.

Smoking is a difficult habit to overcome at anytime.  Only 20% of patients will be able to successfully control tobacco dependence during their pregnancy.  Nurses should recommend that patients stop smoking before pregnancy or as early on in the pregnancy as possible. The results of continued smoking can include preterm birth, low birth weight and many other adverse outcomes.

Exposure to viruses such as measles, mumps, and rubella during pregnancy carry an increased risk for birth defects.  Exposure created through MMR vaccination can also carry a similar risk.  It should, therefore, never be administered if there is any question of an early pregnancy.  Other infectious threats to a developing pregnancy include: Hepatitis B and the vaccine (which can result in hepatic failure, liver carcinoma, cirrhosis, and death), HIV, AIDS, and sexually transmitted diseases.

Obesity should also be addressed prior to pregnancy, as well as diabetes and maternal phenylketonuria (PKU), as these also carry significant risk factors for birth defects.  However, when these are monitored and proper care is given the odds of developing a birth defect can be reduced.

Whether you work in a prenatal environment or any other, if you know someone who is considering a pregnancy make sure they understand there is more to think about than booties and college funds.  Prevention is the best medicine we can offer to reduce the number of birth defects in the next generation.

 

 

References accessed January 2008:

CDC. Fast Facts About Medication Use During Pregnancy and While Breastfeeding http://www.cdc.gov/ncbddd/meds/fast.htm

 

Bailey, L. B., Berry, R. J. Folic acid supplementation and the occurrence of congenital heart defects, orofacial clefts, multiple births, and miscarriage. American Journal of Clinical Nutrition. May 2005, 81:5, 1213S-1217S. http://www.ajcn.org/cgi/content/full/81/5/1213S

 

CDC. Basic Facts About Birth Defects. Frequently Asked Questions.

 http://www.cdc.gov/ncbddd/bd/facts.htm

 

Williams, L. J., Correa, A., Rasmussen, S. Maternal lifestyle factors and risk for ventricular septal defects. Wiley Interscience Journal.  70:2, 59 – 64.

Published Online: 12 Jan 2004  http://www3.interscience.wiley.com/cgi-bin/abstract/
106599819/ABSTRACT?CRETRY=1&SRETRY=0

 

Preconception Risk Factors for Birth Defects. Journal of Christian Nursing

July/September 2007, 24:3,  131.  http://www.nursingcenter.com/library
/JournalArticle.asp?Article_ID=728366

 

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