Preventing Birth Defects Begins Before Conception

Birth_Defects_Prevention_Month_buttons_03_300x250This January, National Birth Defects Prevention Month, let’s dedicate ourselves to educating our patients about the importance of preconception planning – and lifelong health.

According to the CDC, birth defects affect 1 in 33 babies in the US every year, and 18 babies die each day as a result of a birth defect. Some are caused by genetic factors such as Down syndrome or sickle cell anemia. Others are caused by certain chemicals or drugs, including alcohol and tobacco. Unfortunately, however, the cause of many birth defects is not yet known.

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International Meetings with a Focus on Local Care

As ACOG president, I have the honor and privilege of representing US ob-gyns on an international level. This has been most exciting. In the last two weeks, I have attended the annual meetings of the Society of Obstetrics and Gynaecology of Canada (SOGC) in Calgary, and the Royal College of Obstetrics and Gynecology (RCOG) in Liverpool. It was particularly rewarding to watch our very own Dr. James Martin, an ACOG past president, become an honorary fellow of RCOG for his extensive work in hypertension. At these meetings, I was struck by the diversity of the attendees and the deep interest in global women’s health. I was also surprised and inspired by the similarities in priorities we share with our overseas colleagues.

RCOG is working toward a goal of improving maternal outcomes. RCOG President Dr. Tony Falconer, shared reports and responses to the UK’s National Health System and discussed safety in labor and delivery. He referred to all of the fellows as the “eyes and ears of the profession” who will need to address lifelong leadership and quality goals. RCOG is also setting expectations at UK delivery centers for all who provide care. Just as they are looking to improve outcomes, so are we. With our National Maternal Health Initiative, we can focus on both quality and safety in every delivery center in the US by developing standards and expectations on how to provide the best care.

Dr. Chiara Benedetto, the first female president of the European Board and College of Obstetrics and Gynaecology, is working with each of the European nations to develop expectations for the well-woman visit. We hope to accomplish the same thing in the US with our partners in family practice, internal medicine, and pediatrics, including nurse practitioners, nurse-midwives, and physician assistants. Clearly, we all agree that we must address the health of women BEFORE they conceive through improved well-woman care and contraception.

The take-home message: We are all facing the same pressures. Ob-gyns around the globe are extremely dedicated physicians who want what is best for our patients. We need training, standards, and support in developing the systems to provide the best care, and time is of the essence. As many have said, “We do not need to reinvent the wheel.” This is an especially important point as we share our global initiatives and recognize the importance of engaging each country in improving maternal health care and outcomes. We can make changes for Every Woman, Every Time, because—no matter where we live—if we put our patients first, we will succeed.

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Plan for the Unexpected

You may have heard the statistic that roughly half of all US pregnancies are unplanned. As ob-gyns, we worry about this number because many women discover that they are pregnant before they’ve had a chance to make lifestyle changes from which they and their developing fetuses can benefit. The days that immediately follow conception are some of the most important in the development of a child, so it’s never too early to prepare for a healthy pregnancy, birth, and baby.

ACOG encourages all reproductive-aged women to talk to their doctors about preconception care whether actively trying to have a baby or not. You can discuss your desire for children, the optimal time to have them, the amount of space you’d like between pregnancies, and your current birth control needs. Your doctor can also review personal health information that could affect a future pregnancy, such as family medical history, environmental and work-related exposure to harmful substances, the risk of sexually transmitted infections, and substance abuse.

If you are considering having children, your doctor may suggest some changes before you conceive:

  • Enrich Your Diet. Folic acid and other vitamins and minerals are vital for healthy fetal development, but most women do not receive enough of these nutrients in their diets. It’s a good idea to begin taking a prenatal vitamin before pregnancy.
  •  Get Enough Exercise. If you do not currently get at least 30 minutes of exercise on most days, your doctor may recommend that you increase activity now for a more active and comfortable pregnancy later.
  •  Achieve a Healthy Weight. Being overweight can cause high blood pressure and diabetes, put extra stress on your heart, and increase the chance of having a very large baby. Underweight women may find it difficult to conceive and are at risk of delivering low-birth-weight babies. Aim to fall into the normal BMI range for your height.
  •  Control Preexisting Medical Conditions. Women with medical conditions such as diabetes, high blood pressure, seizures, heart disease, or obesity may need special care during pregnancy or may be using medications that are harmful to fetuses. Try to get your condition under control and discuss the safety of all current medications with your doctor.
  •  Confront Substance Abuse. Smoking, drinking, and using illegal drugs have been proven to cause birth defects in newborns. Women contemplating pregnancy should not use these substances.