January is National Birth Defects Prevention Month
Margo Kerrigan, M.P.H., Area Director
Indian Health Service California Area Office
January is National Birth Defects Prevention Month, sponsored by the National Birth Defects Prevention Network.
What is a birth defect?
A birth defect is a problem that happens while a baby is developing in its mother's womb. Most birth defects happen during the first 3 months of pregnancy. One of every 33 babies is born with a birth defect in the United States. A birth defect can affect almost any part of the body and can vary from mild to severe.
Some women have a higher chance of having a child with a birth defect. Women over the age of 35 years have a higher chance of having a child with Down Syndrome than women who are younger. Other defects are caused by environmental or behavioral factors. For instance, if a woman takes certain drugs while pregnant, this can increase the chance she will have a baby with birth defects. Similarly, women who smoke or use alcohol while pregnant have a higher risk of having a baby with certain birth defects.
Fetal Alcohol Syndrome: The most preventable birth defect
Heavy drinking during pregnancy can cause Fetal Alcohol Syndrome (FAS). Children with FAS have abnormal facial features, growth retardation, and central nervous system problems. They may exhibit learning disabilities, social and behavioral problems, memory and attention span difficulties, and vision and hearing deficiencies. FAS is a permanent condition and is the leading known cause of mental retardation. FAS can be prevented completely, if a woman does not drink alcohol while she is pregnant.1
While FAS is the most devastating result of heavy alcohol use during pregnancy, there are other prenatal alcohol-related conditions, including Alcohol-Related Neurodevelopmental Disorder (ARND) and Alcohol-Related Birth Defects (ARBD) that can result from alcohol consumption. ARND manifests itself as central nervous system developmental abnormalities and/or behavioral or cognitive abnormalities. ARBD defects include those of the heart, kidneys, and vision and hearing defects. ARBD defects are believed to occur approximately three times as often as FAS.2
FAS in American Indian/Alaska Native communities
Rates of FAS have been found to be up to four times as high in AI/AN populations than in the general population.
Studies have found alcohol consumption rates among AI/AN women of childbearing age to be higher than average. One study of alcohol consumption in Alaska found that the prevalence of heavy drinking among AI/AN women was 32%, compared to 15% of non-AI/AN women. AI/AN women were also found to have less knowledge of the harmful effects of alcohol on developing fetuses than non-AI/AN women.3
What can women do to prevent FAS and other birth defects? There is no degree of alcohol consumption which has been determined to be "safe" for a pregnant woman. If she is already pregnant, the sooner a woman stops drinking, the better it will be for both her baby and herself. If a woman is not able to stop drinking, she should contact her doctor, local Alcoholics Anonymous, or local alcohol treatment center. Even if she is not pregnant, if a woman is sexually active and is not using an effective form of birth control, she should not drink alcohol. She could become pregnant and not know it for several weeks or more
The CDC recommends prevention efforts be targeted at both pregnant women who are currently drinking, but also women who could become pregnant, are drinking at high-risk levels, and are engaging in unprotected sex..4 The US Preventative Services Task Force recommends screening and behavioral counseling interventions to reduce alcohol misuse by adults, including pregnant women, in primary care settings. Studies in the general population show that behavioral counseling interventions on alcohol misuse are effective among women of childbearing age, and that brief intervention with counseling significantly reduces the rate of alcohol use during pregnancy among women with a history of heavy drinking.5
FAS prevention is a priority for the Indian Health Service. The IHS has a GPRA measure related to FAS prevention: alcohol screening for women of childbearing age. This measure was included in the "One HHS" 10 Department-wide Management Objectives to achieve a relative increase 10 percent increase over FY 2005 rates by FY 2007. IHS met and exceeded that targeted increase. In FY 2007, the Indian Health Service screened 41% of women aged 15-44 for alcohol use at IHS and tribal sites, compared to 28% in FY 2006 and 12% in FY 2005. The IHS 2010 goal for this measure is to reduce the overall rate of FAS through screening and intervention to reduce alcohol use in women of childbearing age.
Other birth defect prevention strategies
While screening for alcohol use can help prevent FAS and related alcohol spectrum disorders, there are further steps that can help prevent other types of birth defects.
A woman can lower her chance of having a baby with birth defects by:
- Taking 400mcg of folic acid every day (to help prevent Spina Bifida or "open spine," a birth defect which occurs in about 1,300 babies each year)
- Not smoking
- Not using illegal drugs
- Consulting with her doctor about using certain medications (including certain drugs for acne) that are associated with birth defects
- Washing her hands often with soap and water to prevent infection
- Seeing a health care provider regularly
Regular health care is essential for women who are planning to have a baby. Women can schedule a "preconception" visit to assess their health status before pregnancy. During this visit, the provider can identify, and often treat, health conditions that can pose a risk in pregnancy. The provider also can make sure that any medications a woman takes are safe during pregnancy and that all vaccinations are up to date. A preconception visit is especially important for women with chronic health conditions, like diabetes, high blood pressure and epilepsy, which can affect pregnancy. For example, women with diabetes who have poor blood sugar control are several times more likely than women without diabetes to have a baby with a serious birth defect. However, if their blood sugar levels are well controlled starting before pregnancy, they are almost as likely to have a healthy baby as women without diabetes.
CDC National Center on Birth Defects and Developmental Disabilities (NCBDDD)
National Birth Defects Prevention Network
March of Dimes
1CDC. Fetal Alcohol Information web page: www.cdc.gov/ncbddd/fas/fasask.htm
2Hankin, JR. Fetal Alcohol Syndrome Prevention Research. Alcohol research & health : the journal of the National Institute on Alcohol Abuse and Alcoholism. 2002;26(1):58-65
3Prevalence and characteristics of alcohol consumption and fetal alcohol syndrome awareness--Alaska, 1991 and 1993. MMWR. Morbidity and Mortality Weekly Report. 1994 Jan 14;43(1):3-6.
4CDC. Fetal Alcohol Information web page. www.cdc.gov/ncbddd/fas/fasask.htm
5US Preventative Services Task Force. Screening and Behavioral Counseling Interventions in Primary Care to Reduce Alcohol Misuse, April 2004. http://www.ahrq.gov/clinic/uspstf/uspsdrin.htm ; Hankin, JR. Fetal Alcohol Syndrome Prevention Research. Alcohol research & health : the journal of the National Institute on Alcohol Abuse and Alcoholism. 2002;26(1):58-65