Preventing Birth Defects

As she walked out of the new born unit, my mind drifted back to the phone call I had heard her make…”it is just a small swelling on her back. Something that will definitely close on its own ….” her words kept going round and round in a circle in my mind; just small swelling on her back, something that will definitely close on its own, just a small swelling on her back, something that will close on its own, just a…. I had spent at least one hour explaining to her that her baby girl had spina bifida, a neural tube defect that would need surgery. I had told her that even after surgery, her child would still have problems with movement, and bladder and bowel continence. I had thought she had understood but when I heard her making that phone call, I kept wondering; if she was she still in shock or she had chosen to be overly optimistic, or if she was just trying to re-assure another person, or if she was just being a mother and thinking best thoughts for her child.

No woman carries a pregnancy to term expecting to give birth to a less than perfect child. The shock that normally comes with realizing that your child is ‘not perfect’, that your child has a birth defect is therefore understandable. Being that January is “the National Birth Defects Prevention month”, I would be happy if you took some time off to read a little about preventable birth defects.

Here are some of the causes of preventable birth defects:
 ALCOHOL-
No amount of alcohol is safe to drink while pregnant.
Drinking alcohol while pregnant may result in; FETAL ALCOHOL SPECTRUM, a disorder characterized by; 1. Facial anomalies; small head circumference, small eye opening, flat upper lip
2. Intra-uterine growth restriction and poor weight and height gain after birth and
3. Learning or behavioral abnormalities.
People who are planning to conceive should therefore refrain from drinking and stay alcohol free throughout the pregnancy.

 FOLIC ACID DEFICIENCY
Pregnant women are usually given folic acid supplements throughout pregnancy.
Folic acid deficiency may lead to neural tube defects such as spina bifida and anencephaly
Ideally, women who are planning to conceive should prepare for conception by starting to take their folic acid tablets at least three months prior to conception.
The problem about our society is that, people ‘find’ themselves pregnant, most pregnancies are never really planned. In this case then, you should start taking your folic acid tablets as soon as you find yourself pregnant and not wait till the pregnancy is advanced like the way most people do.

 PRESCRIPTION DRUGS
Drugs that cause birth defects are known as teratogenic drugs in the medical world.
Women who have chronic illnesses and are on drugs should first discuss with their doctors and have their drugs changed to safer ones before they get pregnant.
Pregnant women should also avoid buying drugs over the counter because they may not know if a particular drug is safe for their unborn children.

Some of the commonest teratogenic drugs include;
1. Drugs used in the treatment of epilepsy- carbamazepine{tegretol}, phenobarbitone and phenytoin[epilim].
2. Some drugs used to treat hypertension- eg enalarpril, lisinopril etc
3. Some antibiotics like amikacin, gentamycin, may cause deafness
4. Drugs used in the treatment of cancer, like thalidomide may result in phocomelia, a disorder where someone is born without limbs
5. Some ARVS like Dolutegravir-has a potential risk for spina bifida

 MATERNAL OBESITY
Having a body mass index (BMI) of more than thirty percent is associated with a risk of heart defects in your child.
Women intending to become pregnant should therefore try and lose weight before becoming pregnant to reduce the chances of getting a child with heart defects

 INFECTIONS
Pregnant women should be screened and treated for the following infections; toxoplasmosis, rubella, cytomegalovirus, herpes simplex,
All pregnant women should routinely be screened and if found to be infected, they should be treated.
If untreated, cytomegalovirus may cause anomalies such as hearing loss, vision loss or mental disability.
Toxoplasmosis may result hearing loss, or even visual impairment in a newborn.

BEFORE YOU CONCEIVE

Get ready. You do not want to be that woman who “finds” herself pregnant eight weeks into the pregnancy when their doctor points out that the anti-malarial drugs did not in fact fail, that they had no malaria in the first place, and that their nausea and vomiting is here to stay until they are done with their first trimester. Before you get pregnant, do yourself and your unborn (or is it un-conceived?) child a favor, take time and get healthy. This is the crucial part you will play in ensuring you give birth to a healthy baby with no birth defects, at term.

Here are the things you need to do before embarking on the too serious, too important baby making process;

1. GET SCREENED FOR INFECTIONS

To have a healthy baby, you need to be healthy;

-Get your partner and yourself screened for infections such as HIV, hepatitis, rubella, HPV, and other sexually transmitted infections like gonorrhea.

-If any of this infection is found present, then it will be absolutely necessary to get treated before you conceive.

Mother to child transmission occurs with infections like HIV, while rubella is known to cause hearing and visual defects!

2. SUPPLEMENTATION

Folic acid –

There is a vivid picture ingrained in my memory of a young girl seated on a wheel-chair asking her mother, “why didn’t you take the damn folate!?”

Most women start their folate and iron supplements when they have been pregnant for a long while, others never start at all!

All intending mothers should start taking folic acid supplements 8-12 weeks before conception

Supplementation can be in the form of tablets available as over the counter drugs sold in pharmacies or in diet

Foods rich in folic acid are dried beans, peas, nuts, avocado, lentils, spinach, citrus fruits.( given a woman could become pregnant even by accident, all women should always make sure their plates are over-flowing with these food stuff.

Deficient folic acid leads to spina bifida and other neural tube defects

Women who have had children with spina-bifida, diabetic women, women taking anti-epileptic drugs and those with a BMI of 35 and above MUST take supplements of folic acid before getting pregnant to reduce chances o getting malformed babies.

Iron

Many pregnant women suffer anemia due to low iron levels. Anemia could be detrimental to both baby and mother and therefore should be prevented

Pre-conception, women should increase their iron in diet.

Sources- spinach, liver, egg-yolk, beans.

Where it is difficult to take it in food, then women should take supplement tablets

Vitamin

Other important vitamins should be supplemented like vitamins C, and B.

3. RISK REDUCTION

Chronically ill women require the approval of their doctors before becoming pregnant (ideally)

Diabetic, hypertensive, epileptic, HIV positive lupus, heart failure and other chronically ill patients should discuss with their physicians before becoming pregnant.

Such patient should discuss their drugs and their possible side- effects on their unborn babies.

They should discuss possible pregnancy outcomes, (women with lupus are likelier to suffer miscarriages,) the effect of pregnancy on their conditions (pregnancy will worsen heart failure) and the effect of their conditions on pregnancy.

Where necessary, their doctors will stop some o their drugs and re-introduce new ones, or will advise against getting pregnant if at all pregnancy will be too risky for the mother.

4. BLOOD GROUPING

Both the father and mother-to-be should have their blood grouped.

This allows detection of rhesus incompatible parents early, and a frame-work for intervention is drawn.

5. DRUGS

Smoking- intending mothers should quit first hand and second hand smoking if they intend to have children weighing any more than one kilogram (you do want a baby who is heavier than a kilo of sugar right?

Alcohol and other alcoholic drinks, wine included!

Alcohol consumption and pregnancy should not be mentioned in the same sentence (except how I did it there, hehe).

Alcohol has untoward effects to an un born child including but not limited to, an abnormal facial appearance, low intelligence, and behavior problems. You don’t want to do this to your child.

Quit even before you get pregnant, and have your partner quit in solidarity with you (this is just to reduce temptations, apparently, a drunk sperm doesn’t cause fetal, alcohol syndrome, a drunk other does)

6. OTHERS

Pregnancy is no easy feat, and you need to be prepared psychologically so you can puke gracefully, grow fat and not give a damn, and look at the stretch marks on your tummy and chuckle.

Prepare the finances, for some reason, pregnant women get sick more often, eat more, and need new clothes every month

All women need pre-conception care.