Reduce Birth Defects with Folic Acid

By Richard N. Waldman, MD
President, The American Congress of Obstetricians and Gynecologists

Approximately 2,500 children each year in the US are born with defects of the neural tube—the part of a growing fetus that will become the brain and spinal cord—which can cause severe mental and physical disability or death. Spina bifida, the most common form of neural tube defect, occurs when the bones of the spine do not completely form around the spinal cord. Anencephaly, another defect, is a fatal condition in which an infant is born missing parts of the brain.

Folic acid—an essential B vitamin necessary for proper cell growth and vital to the development of a baby’s neural tube and central nervous system—is an integral component in preventing birth defects. Women who get enough folic acid have a 50–70% reduced risk of having a baby with neural tube and other defects, such as cleft lip and palate.

Folic acid is most effective when it is abundant in a woman’s body before she gets pregnant and during the first three months of pregnancy, around the time when the neural tube begins to develop. Neural tube defects occur in the first weeks of fetal development, often before a woman even knows she is pregnant. But because nearly half of all pregnancies in the US are unplanned, many women are at risk of beginning a pregnancy with a folic acid deficiency.

Therefore, The College recommends that all women of childbearing age take a daily multivitamin that contains 400 micrograms (.4 milligrams) of folic acid, regardless of whether they are currently planning a pregnancy or not. Taking folic acid before pregnancy ensures that the nutrient is present, even if an unplanned pregnancy occurs or if a pregnancy is not discovered for several weeks.

It’s also a good idea to eat a diet rich in natural sources of folic acid including leafy green vegetables, citrus fruits, and beans, and folic acid-enriched grain products, such as breads, cereals, flours, pastas, and rice. Most women will still need a supplement because it can be difficult to meet the daily requirement through food sources alone.

Women who have had a child with a neural tube defect or certain other birth defects, are pregnant with twins, have particular medical conditions (such as sickle cell disease), or take some forms of medication (such as antiseizure medication) require 10 times the amount of folic acid recommended for most women. A daily 4,000 microgram (4 milligram) folic acid supplement can be prescribed. Women should not consume large amounts of folic acid through regular multivitamins because the quantities of other vitamins and minerals included may be harmful.

For more information, the ACOG Patient Education Pamphlet “Reducing Your Risk of Birth Defects” is available in English and Spanish at

www.acog.org/publications/patient_education

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Prescription Painkiller Use Linked To Serious Birth Defects

by Nancy Shute

Women who use oxycodone, codeine and hydrocodone painkillers early in pregnancy may increase the risk of birth defects, according to a study led by researchers at the Centers for Disease Control and Prevention.

Women who used these prescription pain medications just before they got pregnant, or in the first trimester of pregnancy, were twice as likely to have a baby born with a serious heart defect, the researchers report in the American Journal of Obstetrics and Gynecology.

As far back as the 1970s, studies have shown a link between using opioid painkillers in the first trimester of pregnancy and birth defects. But that didn't change doctor's prescribing practices at all, says Cheryl Broussard, the CDC epidemiologist who led this new study. She looked at data from the National Birth Defects Prevention Study, which has been collecting information on women's use of medications since 1997.

Heart defects saw the greatest increase, including hypoplastic left heart syndrome, in which the left side of the heart doesn't develop properly. It is fatal if not treated with surgery.

And this is the first study to link spina bifida, in which the backbone and spinal canal don't close before birth, with opioid use.

The new study also found slight increases in congenital hydrocephaly, which can cause mental retardation; congenital glaucoma; and gastroschisis, in which a baby is born with intestines outside the body.

The increased risk of birth defects for each woman was very small overall. For instance, the risk of having a baby with hypoplastic left heart syndrome rose from 2.4 per 10,000 live births, to about 5. But almost 3 percent of women say they use prescription opioid pankillers while pregnant; they are commonly prescribed for pain from surgery, infection, chronic illness and injuries. About 1 in every 33 babies in the U.S. is born with a birth defect.

Many women — and their doctors — don't realize that these popular painkillers could pose a risk to their babies, Broussard says.

"It's really important that women talk with their doctors," she says, "and talk about the potential benefits for these medications, as well as the potential risk for heart defects."

http://n.pr/gzj68b