How mothers can avoid having babies with birth defects

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How mothers can avoid having babies with birth defects

Written by Sade Oguntola Tuesday, 16 August 2011

Most babies with birth defects are born with no obvious health problems or risk factors. Nonetheless, experts say part of what women can do to ensure that they do not have babies with birth defects, such as spina bifida, include adopting good lifestyles, as well as using folic acids supplements at least three months before getting pregnant, reports Sade Oguntola.

There is much that can be done to help prevent birth defects. No one likes to see babies suffer or die from birth defects that could have been prevented.
Education is one key to helping women prepare before becoming pregnant and also to do whatever is necessary during pregnancy to have a healthy baby.

Education begins with teaching young girls about sexual diseases that could affect their future children. It also includes learning about lifestyle choices that can affect the health of the baby or lead to birth defects including smoking, drinking alcohol and nutrition as well as the need for prenatal care.

Certainly, most people have heard that pregnant women should eat healthy, get exercise, take vitamins, including folic acid, avoid tobacco and alcohol in order to have a healthy baby but there are other things that can be done to ensure that a healthy baby, without any defects is born. Research shows that many birth defects can be prevented with a little advanced planning. One of such steps is intake of folic acid supplements at least three months before getting pregnant in order to ensure that there is enough folic acid in the system before pregnancy and during the early weeks of pregnancy, before the neural tube closes.

Insufficient levels of folate have been implicated as the cause of one common class of birth defects called neural tube defects. These defects occur very early in the pregnancy, well before the woman’s first prenatal appointment, which is generally scheduled at 10 weeks.

Scientists have found that intake of folic acid and iron tablets helps to reduce the possibility of a pregnant woman delivering a baby that has a low birth weight rates by 17 per cent and birth complications such as spina bifida and hydrocephalus, thus making intake of these micronutrients to offer the highest possible return for the investment.

Folic acid, the naturally occurring form of folate, when taken one month before conception and throughout the first trimester, has been proven to reduce the risk for neural tube defect (NTD) in babies by 50 to 70 per cent. It is a B vitamin found naturally in leafy vegetables, citrus fruits such as oranges, beans, and whole grains. Folate and folic acid are interchangeable terms; folic acid is the synthetic form of folate. Also, folic acid usually breaks down in the body to folate.

The intake of folic acid supplements at least three months before getting pregnant is particularly important for Nigerian women, especially with the lifelong burdens, both in human and financial terms, of central nervous system (CNS) congenital anomalies now impossibly staggering, even in the developed countries with well funded and more effective systems of healthcare financing, declared Dr Femi Adeleye, a paediatric neurosurgeon at the University College Hospital (UCH), Ibadan, Oyo State.

According to him, the findings of a recent study that revealed that children with spina bifida incur 13 times more medical expenditures than those without, hence the need to consider the global prevention of birth defects, including those of the CNS, a red-alert emergency.

“Congenital CNS anomalies are known to be fairly responsive to preventive measures. First, intake of folic acid supplements at least three months before getting pregnant greatly reduces the incidence of neural tube defects (NTDs) at birth by as much as between 50 and 70 per cent, while, secondly, early ultrasound scan allows early detection of many of these anomalies, allowing the possibility of termination of such pregnancies in extreme situations.”

A neural tube defect (NTD) occurs when the bony protection fails to close properly, leaving the developing brain or spinal cord exposed to the amniotic fluid and, vulnerable. The two most common neural tube defects are anencephaly and spina bifida. Hydrocephalus is one of the common medical problems of spina bifida. The diagnosis of these abnormalities is easily and cheaply achievable with well-performed ultrasound scan. An ultrasound scan can pick up cases as early as 16 weeks of gestation.

Unfortunately, birth defects are a silent and unrecognised epidemic in many African countries, including Nigeria, where they affect children of low-income and financially incapacitated parents who are usually unable to afford the costs of the medical care in these countries without any measurable positive health behaviour, both individually and corporately, towards the prevention of CNS anomalies.

Yet, “a study at the Lagos State University Teaching Hospital, Ikeja, between January and December of 2005, recorded 61 cases of CNS birth defects. There were more males than females and their age at the time they were brought to the hospital (LUTH) ranged from two days of life to 60 months. This number of cases coming from a single neurosurgical unit is somewhat large compared with the rest of Africa and the other low and medium-income countries,” Dr Adeleye declared.

According to him, studies from many African countries suggested that birth defects such as spinal bifida may be an unrecognised major public health issue in Africa and other low and medium income countries. Unfortunately, “there is actually no national register that we know of on the prevalence of CNS birth defects such as spina bifida, but empirical evidence is that it is indeed a major health problem in Nigeria,” he explained.

“Yet, CNS anomalies, especially the NTDs, are known to be amenable to preventive measures, both primary and secondary. Even in industrialised economies with much better funded healthcare financing systems, a global understanding of the huge, unbearable socioeconomic costs of attending to the lifelong healthcare needs of people living with CNS birth defects has forced urgent attention to be called to these preventive measures especially the supplementation of diets of females in the childbearing age with folic acid,” he stated.

But “this is hardly obtainable in many low and medium income countries. For instance, in the studied group at LUTH, many (30 per cent) of the pregnancies in the first instance were unregistered with certified health practitioners; hence, their micronutrient supplementation could only be presumed to be zero. The supervised pregnancies, on the other hand, booked and probably then started their obstetric micronutrient supplementation, in the second trimester or even later. This is way too late for the prevention of NTDs because the development and closure of the neural tube are normally completed by the end of the first 4 weeks after conception.”

At the community intervention level, fortification of staple foods such as wheat flour known to be heavily consumed is perhaps the best known means of ensuring that all women of childbearing age have daily folic acid supplementation of their diets. However, “there is no known national policy on folic acid fortification in Nigeria, for instance; despite the country’s fairly salutary history with other fortification programmes for iodine and vitamin A through the efforts of the national regulatory agency, the National Agency for Food and Drug Administration and Control (NAFDAC).”

To this end, Dr Adeleye called on the policy formulators to urgently take steps towards folic acid fortification of common staple foods for the benefits of women in the childbearing age, as well as the complete overhauling, including greatly increased government and international funding of the general, and reproductive, healthcare systems.