January marks the US government Centers for Disease Control and Preventions' Birth Defects Prevention Month.
What You Need to Know
According to the CDC, some birth defects can be prevented by adopting healthy behaviours before and during pregnancy
Taking daily folic acid supplements can help prevent neural tube defects like spina bifida
Maintaining a healthy weight can lower the risk birth defects such as congenital heart disease, and those involving the brain and spinal cord
It's important to check your vaccinations are up-to-date, as some infectious diseases can result in birth defects
Living clean may help protect your future baby: the use of alcohol, tobacco and other drugs have been linked to increased risks of birth defects
Certain prescription and over-the-counter medications (known as "teratogens") cause problems with fertility and a baby's development
Approximately 150,000 children are born every year in the United States affected by one or more birth defects.
The CDC says that although the causes of many birth defects are not known, and not all can be prevented, you can reduce your risk of by "adopting healthy behaviours before and during pregnancy."
Here are their 5 most important tips on how you can prevent birth defects in the pre-conception period (whether that's before egg freezing, IVF, or non-assisted conception)...
1. Take 400 micrograms (mcg) of folic acid every day
Folic acid (also known as folate) is important because it can help prevent some major birth defects that form early in pregnancy. In particular, folic acid is thought to reduce the number of neural tube defects that affect babies’ brains and spinal cords that result in conditions like spina bifida.
Demand for folate increases during pregnancy due to its role in the growth and development of the baby.
The advice is to start taking folic acid at least one month before becoming pregnant and continue during pregnancy. The research is so compelling that the CDC actually recommends that all women of reproductive age take a folic acid supplement per day just in case, not even those actively trying to get pregnant.
Even if you're egg freezing and not trying to get pregnant any time soon, you might want to consider taking this power pill. Studies have shown women undergoing ovarian stimulation who were supplemented with folic acid experienced:
- An increased number of eggs retrieved
- Improved quality of eggs retrieved
- Higher overall success rates in fertility treatments
- Lower frequency of natural infertility
- Lower risk of miscarriage
Where folate is found
Some food are naturally rich in folate, such as:
- Leafy greens
You can also find folic acid in some fortified foods like breads, breakfast cereals, and corn masa flour.
Why take a supplement?
Although most Americans consume adequate amounts of folate in their diets, taking a folic acid supplement is recommended because, ironically, women of childbearing age are more at risk of insufficient folate intakes than other people. Even when intakes of folic acid from dietary supplements are included, 17% of women aged 19 to 30 years still do not get the daily requirement.
While the folate found in foods is better absorbed than synthetic versions, it is a water-soluble vitamin, so the body cannot store it - you'd have to eat adequate amounts every day - which is another reason most doctors recommend daily supplementation.
Methylfolate or folic acid?
Some people prefer to take a supplement of methylfolate (also known as L-methylfolate, 5-MTHF, and 5-methyltetrahydrofolate) instead of folic acid.
Recently it has been argued that methylfolate is preferable to folic acid as a nutritional supplement. Some manufacturers have replaced folic acid with methylfolate in their multivitamin product.
This is because methylfolate appears to be more bioavailable than folic acid. In addition, 5-15% of the population might have difficulty converting folic acid to its biologically active form.
However, so far, most medical professionals say there is not sufficient evidence to justify routinely using methylfolate instead of folic acid.
What to take
Look for a good quality multivitamin that has folic acid in it. Check the label on the bottle to be sure it contains 100% of the daily value (DV) of folic acid, which is 400 mcg.
2. Reach a healthy weight
Obesity increases the risk for several serious birth defects, as well as other pregnancy complications.
Researchers have found a sliding scale of risk: the heavier the mother, the higher the risk.
Data shows obese women (women with a BMI of 40 or more) were 37% more likely to give birth to a baby with a birth defect than a woman of a healthy weight.
In another study, babies born to obese moms were twice as likely to have spina bifida even though the women were just as likely to take pre-conception folic acid supplements.
However, in reality the actual risk only goes up by 1.3%. Whereas the average birth defect risk is around three in 100 births among babies born to normal-weight mothers, this rises to about four out of 100 babies born to obese mothers.
Defects affecting the heart, brain and spine are the most common defect in babies of obese women.
Before you try to conceive, or before your ovarian stimulation cycle (depending on the time available to you) it's beneficial to try to reach a healthy weight.
If you're struggling to find balance alone, talk to your healthcare provider about ways to reach and maintain a healthy weight. Note that being underweight or over-exercising is also linked to poorer reproductive health outcomes, so aiming for a "fertility friendly" BMI of between 20 - 24.9 is optimal.
Focus on a lifestyle that includes healthy eating and regular moderate physical activity and avoid crash diets, which can have a negative effect on your reproductive hormones.
3. Check if your vaccinations are up-to-date
Vaccines help protect you and your future developing baby against serious diseases.
Chickenpox and rubella infections during pregnancy can cause miscarriage and serious birth defects, such as deafness.
The best protection against rubella is the MMR vaccine. If you aren't sure if you've had to MMR or if you're up to date, you can have a simple pre-pregnancy blood test to see if you are immune to the disease. If you do need the vaccine, it's advised to get it at least one month before getting pregnant (or undergoing ovarian stimulation).
The CDC also advises women to get a flu shot vaccine (also called Tdap) before or during each pregnancy to help protect yourself and your baby, and you can get the whooping cough vaccine in the last three months of each pregnancy.
Are vaccines safe?
The recent amplification of a phenomenon that the World Health Organisation calls "vaccine hesitancy" - encouraged by the "anti-vaxxer" movement - led to it being listed as one of the WHO's top 10 global health threats of 2019.
While vaccines can cause localised irritation, tenderness and redness at the injection site, and occasionally can cause more severe side effects, such as fever, these are mostly temporary.
Numerous studies have found no evidence to support the claims that vaccines cause autism and other chronic illnesses. The main risk with vaccination is an allergic reaction.
Some facts that worry health-conscious individuals, such as the presence of aluminum in some vaccines (to improve immune response) cannot be looked at isolation. Babies actually get more aluminum from breast milk or formula during their first six months than they do from vaccines.
Overall, every major government, health organisation and institute advises that the proven benefits of vaccinations (providing resistance to infectious diseases that can kill and maim) far outweigh the potential risks and unfounded claims of danger.
Read more on vaccine myths debunked.
4. Clean up your lifestyle
You can boost your health and protect your future child by avoiding substances that are harmful during the pre-conception period and pregnancy.
Alcohol: According to the NHS, experts are still unsure exactly how much – if any – alcohol is completely safe to drink while you're pregnant. So although some doctors say the occasional glass of red wine is fine, many women find their preferred approach is not to drink at all during pregnancy.
Most government health advice is that, given the unknowns, the safest approach is not to drink alcohol at all to keep risks to your baby to a minimum. Drinking in pregnancy can lead to long-term harm to the baby, with the more you drink, the greater the risk.
Especially in the first three months of pregnancy, drinking increases the risk of miscarriage, premature birth and your baby having a low birth weight. Drinking heavily throughout pregnancy can cause your baby to develop a serious condition known as foetal alcohol syndrome (FAS) or fetal alcohol spectrum disorders (FASDs).
Tobacco: Most people are aware that smoking causes diseases like cancer and other major health problems. It can also cause fertility problems: women who smoke have more trouble getting pregnant than women who don’t smoke, and male smokers experience damaged sperm and erectile dysfunction.
Smoking raises your baby’s risk for birth defects, including cleft lip, cleft palate, or both. Babies may also be born too small, prematurely, with damaged lungs and brain. Smoking doubles your risk of abnormal bleeding during pregnancy and delivery.
Smoking whilst pregnant:
"Your baby could be born too early, have a birth defect, or die from sudden infant death syndrome (SIDS). Even being around cigarette smoke can cause health problems for you and your baby." - CDC
Other Drugs: Using certain drugs during pregnancy can cause health problems and birth defects in both mother and baby.
Babies born to mothers who use cocaine during pregnancy are often prematurely delivered, have low birth weights and smaller head circumferences, and are shorter in length. Scientists are also finding that exposure to cocaine during the baby's development in the womb may lead to subtle, yet significant, later deficits in some children. These include behavior problems (e.g., difficulties with self-regulation) and deficits in some aspects of cognitive performance, information processing, and sustained attention to tasks—abilities that are important for the realization of a child’s full potential. The effects of many other drugs like cannabis and amphetamines on birth defects are not clear because of the lack of scientific studies.
Your primary healthcare provider can help you with counseling, treatment, and other support services if you are struggling with addiction.
5. Have your medications and supplements evaluated
As well as alcohol and illegal drugs, certain legal prescription and over-the-counter medications are known to cause birth defects if taken during pregnancy.
Drugs that can cause birth defects are called teratogens. A teratogen is a substance that interferes with the normal development of a baby in the womb.
Scientists can't always predict what exposure to a teratogenic drug will result in, because it depends on the size of the dose, how often it’s taken, individual response and other factors. That's partly why one baby may be fine and another harmed by a substance.
Here are some (by no means all) of the drugs or drug groups that may cause birth defects in a developing fetus:
- ACE inhibitors
- Some acne medications such as accutane
- High doses of Vitamin A
- Male hormones
- Some antibiotics
- Some anticonvulsant / epilepsy medications
- Some cancer-fighting medications
- Some thyroid medications
- Some medications that treat rheumatic conditions
It's a good idea to discuss details of any medications or supplements you're taking with your doctor to find out more about risks of birth defects or problems with fertility.
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