Birth defects occur while the baby is developing in the womb. Certain chemicals, medicines, and drugs—called teratogens—can increase the risk of birth defects. Between 15 and 60 days of gestation (during the first trimester), major organs develop. This is when your baby is most susceptible to the effects of teratogens, and severe birth defects can result. Teratogens are not the only cause of birth defects. Genetics also play a role. While there’s no sure-fire way of preventing birth defects, you can take steps to reduce your baby’s exposure to many harmful environmental influences on prenatal development. Maintaining a healthy lifestyle and making regular appointments with your OB-GYN before and during pregnancy can help keep your baby healthy
Avoid Alcohol
Alcohol is a leading cause of birth defects during pregnancy. According to the Centers for Disease Control and Prevention (CDC), there is no known safe amount of alcohol use during pregnancy or while trying to get pregnant. There is also no safe time during pregnancy to drink. All types of alcohol are equally potentially harmful, including all wines and beer. It can take between four and six weeks before a test can detect pregnancy, so it’s a good idea to stop drinking as soon as you stop birth control and start trying to conceive. Alcohol could interfere with fetal development during these early weeks. Fetal alcohol syndrome (FAS) can be a result of alcohol use during pregnancy. Abnormalities associated with the syndrome include:
Heart, kidney, or bone defectsFlattened face secondary to the underdeveloped mid-faceIntellectual disabilityIntrauterine growth restriction (poor growth of the baby while in the womb)Vision and hearing problemsMicrocephaly (small head and impaired brain development)Poor coordination
Researchers have not determined exactly how much drinking leads to FAS, and the exact means by which alcohol causes FAS aren’t fully understood. It is known that alcohol readily crosses the placenta into the fetus’s blood. If you drink while pregnant, the concentration of alcohol in your blood and your baby’s blood will be roughly the same. However, fetuses lack the enzyme needed to effectively metabolize alcohol. Instead, babies rely on placental and maternal enzymes to clear it from their systems. That means your baby will have more trouble processing alcohol than you do. Alcohol may also cause substantial damage to your baby’s nervous system. It not only impairs the development of nerve cells but also kills them (a process called apoptosis).
Stop Smoking
It’s best to quit smoking before getting pregnant; however, for an expectant parent who is still smoking, it’s never too late to quit. A baby born to a parent who smokes during pregnancy may experience:
Cleft lip Cleft palate Intrauterine growth restriction Stillbirth Preterm labor SIDS Tremors
Nicotine can damage a developing baby’s brain and lungs. It’s 15% more concentrated in the blood of the fetus than in that of the gestational parent. The more heavily that a parent smokes, the greater the risk of intrauterine growth restriction. Furthermore, even those who smoke 10 cigarettes or fewer per day (light smokers) put their babies at twice the risk for low birth weight. The effects of vaping and e-cig use on pregnancy are potentially harmful as well, since many of smokeless devices contain nicotine.
Quit Marijuana or Other Recreational Drugs
The CDC advises against using recreational drugs in pregnancy because they’re linked to preterm delivery, low birth weight, and certain birth defects. Marijuana is the most commonly used recreational drug. It is now legal in certain states, which has lots of health experts concerned. There’s increasing evidence connecting marijuana use in pregnancy to neurodevelopmental problems in kids later. These could include impulsivity and hyperactivity as well as challenges with abstract and visual reasoning. Research shows that babies whose parents used marijuana while pregnant are more likely than others to be anxious and aggressive between ages 3 and 6. No safe level of marijuana has been determined for those who are planning on becoming pregnant or are pregnant. The effects of CBD on pregnancy are also largely unknown. Thus, it’s best for people not to smoke or otherwise consume marijuana at conception or during pregnancy. If you need marijuana for a medical condition, discuss this with your OB-GYN.
Reduce Your Risk for Infections
Certain infections during pregnancy can lead to birth defects. Many infections can be prevented by staying away from people who are sick, frequent handwashing, and thoroughly cooking meat. Furthermore, certain vaccines protect a person from infections that can lead to birth defects. The seasonal flu vaccine is always recommended for pregnant people.
COVID-19
While the overall risk is low, pregnant people are at increased risk for severe illness from COVID-19 when compared to non-pregnant people. They are more likely to require hospitalization, breathing support, care in an intensive care unit (ICU), and to die from complications. In addition, COVID-19 may place people at increased risk of poor pregnancy outcomes. Factors that can increase a pregnant person’s risk for severe illness include:
Preexisting health conditionsBeing older than 25Health and social inequities
Some newborns test positive for COVID-19 shortly after birth. It is not known if they contract it in utero, during birth, or after they are born. Fortunately, most newborns with COVID-19 have mild or no symptoms. However, there have been some severe cases. Parents who test positive for COVID-19 at the time of giving birth should take precautions. Wear a mask when you are within six feet of your baby and wash your hands frequently, especially before handling your baby.
Zika Virus
Zika virus causes birth defects in babies born to infected parents. These birth defects include microcephaly (small head) and brain abnormalities. However, the transmission of the Zika virus in the continental United States is still relatively rare, and infection with other teratogenic viruses is much more common.
Cytomegalovirus
Cytomegalovirus (CMV) is the most common cause of infection in newborns. A majority of people have CMV antibodies. Most commonly, primary infection with CMV (infection for the first time) leads to a risk of CMV in the newborn (i.e., congenital CMV). Nevertheless, reactivation of CMV or infection of the parent with a different strain can also lead to congenital CMV. Most people who have been infected with CMV show no signs of infection and experience no symptoms. A person with a healthy immune system can keep infection with CMV in check. However, CMV can cause serious infection in those with weaker immune systems. Moreover, CMV can endanger the fetus and can lead to birth defects. Most babies born with CMV infection are healthy. About one in five babies born with CMV infection are sick at birth or go on to develop long-term health problems. Some babies show signs of CMV infection at birth. A minority of babies appear healthy at birth but go on to later develop signs of infection, such as hearing loss. Other repercussions of CMV infection in newborns include:
Chorioretinitis (inflammation of the choroid and retina) and other eye problemsDental problemsEnlargement of the liver and spleenHemolytic anemia (an autoimmune blood disorder)HepatitisIntellectual disabilityIntracranial calcificationsJaundiceLiver, lung, and spleen problemsMicrocephalyPetechiae (i.e., small red or purple spots on the skin caused by broken capillaries)Psychomotor issuesSeizuresSmall size at birth
It is difficult to predict which babies will develop serious CMV infections, and there is no treatment for CMV infection during pregnancy that will prevent disease in the newborn. CMV can be transmitted from one person to another by close contact, such as sexual intercourse or exposure to saliva.
Discuss Prescription Medications With Your Doctor
Many medications have adverse effects that can affect pregnancy. However, only about 30 drugs are known teratogens, which can cause birth defects. Potential teratogenic effects include the following:
Behavioral toxicities (i.e., adverse effects of drugs that impair the performance of everyday activities)Death of the fetusIntrauterine growth restrictionMalformationsNeonatal toxicities
Until the middle of the twentieth century, physicians believed that the fetus lived in a protected environment separate from the parent. This belief that fetuses were protected from prescription drugs and other potentially toxic substances came crashing down after the effects of thalidomide resulted in widespread tragedy in the 1960s. Thalidomide was used to treat morning sickness but resulted in profound limb malformations, facial malformations, and other problems in newborns. Ever since the thalidomide tragedy, physicians have gingerly approached the prescription of drugs during pregnancy for fear of teratogenic effects. Fortunately, many teratogenic agents are not prescribed during pregnancy. Here are some known drugs that are teratogens:
ACE inhibitorsCarbamazepineCyclophosphamideDiethylstilboestrolIsotretinoinLithiumPhenytoinTetracyclineWarfarin
Supplement With Folic Acid
Folate, or folic acid, is a type of B vitamin. During pregnancy, the need for folate increases between five and ten times because this vitamin is transferred to the fetus. Folate deficiency can be hard to detect during pregnancy, and even a well-nourished person may experience it. Of note, green, leafy vegetables are high in folate. Because half of all pregnancies in the United States are unplanned and folate deficiency can affect a fetus early on—before a person even knows that they’re pregnant—the CDC recommends that anyone who could conceive (between the ages of 15 and 45) should take 400 micrograms of folate daily. Most prenatal vitamins contain more than this (600 to 1000 micrograms). The following factors increase the need for folate in the parent:
Anticonvulsant medicationsBreastfeedingCoexisting anemiaInfectionPoor diet
Folate deficiency can lead to serious birth defects including spina bifida and anencephaly. Both of these conditions are neural tube defects. With spina bifida, the bones of the spine don’t properly form around the spinal cord. With anencephaly, parts of the head and brain don’t properly form. Research shows that folic acid supplementation at the time of conception continued through the first 12 weeks of pregnancy can decrease the risk of neural tube defects by about 70%.
Monitor Chronic Health Conditions
Uncontrolled diabetes during pregnancy as well as obesity before and during pregnancy can both increase the risk of birth defects as well as other serious health conditions. If diabetes is poorly controlled during pregnancy, higher blood sugars can affect both the fetus and the parent. Babies born to parents with diabetes are typically much larger and have larger organs, which makes the birth process much more difficult. These babies also experience low blood sugars after birth. Furthermore, babies born to parents with diabetes are at increased risk of being stillborn, and fetuses are at increased risk of miscarriage. Specific conditions experienced by babies born to parents with diabetes may include:
Blue and mottled skin, rapid heart rate and rapid breathing (signs of lung and heart failure)Congenital heart defectsJaundiceLethargyPoor feedingPuffinessTremors
People with diabetes should try to achieve a healthy weight before conceiving. During pregnancy, people with diabetes should work to limit weight gain as well as exercise, monitor blood sugar, and take medications as prescribed by a physician. Similarly, people with obesity should try to lose weight before conceiving.
