March of Dimes Birth Defects

Understanding
Birth
Defects
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The mission of the March of Dimes is to
improve the health of babies by
preventing birth defects, premature birth
and infant mortality.
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The mission of the March of Dimes is to improve the health of
babies by preventing birth defects, premature birth and infant
mortality.
Part of this mission is accomplished through programs of
education such as this presentation.
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Birth Defects
Every 3 1/2 minutes a baby
is born with a birth defect
in the United States.
Over 150,000 babies are
born with serious birth
defects each year.
In 2001, birth defects
accounted for about 1 in
5 infant deaths in the
United States.
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Today’s topic is birth defects.
Every 3 1/2 minutes a baby is born with a birth defect in the
United States. This means that in the next hour, 16 babies will
be born with a birth defect.
In the United States, over 150,000 babies are born with
serious birth defects each year. Overall, the incidence of birth
defects is one in 20 births. Interaction: So, in your class of
_______ (# of people in class), _____ people (ratio of 1:20)
would have a child born with a birth defect.
While most children with birth defects live, some birth defects
cause death. In 2001, birth defects accounted for about 1 in 5
infant deaths in the United States. Birth defects are the leading
cause of death in the first year of life.
Retrieved April 20, 2005, from www.marchofdimes.com/peristats.
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There are many kinds of birth defects
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Interaction: Have pictures of children with visible and non-visible birth
defects on each desk.
Ask: Who has a picture of a child with a birth defect? (Point out that not
all birth defects are visible and there are many different types.)
Ask: Do you know anyone with a birth defect?
Ask: Do any of you know what types of birth defects are shown on this
slide? What could be the impact of the defect on their lives?
Many birth defects can be prevented and that is why we are here.
There are many kinds of birth defects. Several thousand different birth
defects have been identified. Some happen and we don’t know why.
Others have known causes and are preventable.
A birth defect is an abnormality (something wrong) with the body
structure, function or metabolism that is serious enough to require the
care of doctors and nurses.
Many birth defects can cause permanent disabilities such as mental
retardation, blindness, deafness, paralysis or other physical problems.
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Immunizations
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Prenatal care is very important during pregnancy and in
preventing birth defects. One reason to see a health care
professional is to receive immunizations (shots) that could
protect you and your baby.
Diseases can also cause birth defects. Pregnant women and
children are particularly vulnerable to infectious
disease—that’s why it is critical to get immunized!
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Genetic Mutations
Baby with
Trisomy 13
Boy with
Fragile X
Syndrome
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Ask: What is a mutation? Does anyone know how mutations
occur in babies?
Mutations in genes or chromosomes can cause birth defects.
Some babies with mutations will not be able to live outside of
the mother’s womb. Other mutations cause milder defects,
that may not be noticed for many years.
Sometimes the mutation is passed down to the baby from its
parents but sometimes the mutation occurs (spontaneously)
only in the baby when the sperm and egg join.
The baby on the left has Trisomy 13, a severe and lethal
condition. This baby has an extra #13 chromosome – often
causing heart defects, vision problems, cleft lip/palate and
other problems with organs.
The boy on the right has fragile X syndrome, a less severe
birth defect. This genetic mutation causes some characteristic
facial and body features (large ears, narrow face) and learning
problems.
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Which woman is pregnant?
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Ask: Can any of you tell which of these women are pregnant?
How can you tell?
Do you think they know they are pregnant?
Most women don’t find out that they are pregnant until at least
a month after conception. Other people cannot see any
outward changes on the woman during the first 1 to 3 months.
Yet, there are critical changes going on in the baby’s
development during this time period.
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Human Embryo at 4 Weeks
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Here is a human embryo at four weeks. You can see that in the
28 days since the sperm has joined with the egg, incredible
changes have taken place.
The spine is growing, the brain and other organs are developing
and the heart is beating.
Interaction: Provide small Dixie cup with grain of rice, pinto bean
and small ball/paperclip/etc about 1.5 inches long. Use to relate
to actual size of embryo and fetus at early stages (crown to rump
measurement). Stress that much is going on though it is very
small.
Size of embryo at 4 weeks since conception: 2-4mm/ 0.08-0.16 inches (grain of rice)
Size of embryo at 6 weeks since conception: 14-20mm/0.56-0.8inches (pinto bean)
Size of embryo at 8 weeks since conception: 31-42mm/1.25-1.68 inches (paper clip)
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Human Embryo at 8 Weeks
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Here is a picture of an embryo at 8 weeks. (Question on quiz relates to
this info.)
Ask: What parts of the baby can be seen in this picture? How many
more weeks will it take for the baby to develop all its organs?
Even more changes have taken place. The eyes are starting to develop
and you can see the tiny arms and legs. All the organs have formed
and are continuing to develop!
This first few weeks of pregnancy are a period of time when severe
damage can be done if a pregnant woman drinks alcohol, smokes,
takes drugs, or lacks vitamins from poor nutrition. This is the period
when many important organs are developing their internal structure and
damage during the period can have long lasting effects.
Consider Interaction here – Ask what organs might be affected – ask
what substances might do to organs and what the long term outcome
could be – e.g. brain, affected by alcohol causing delays in mental
development – but let students come up with ideas as speaker will
discuss details in a few slides.
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Drugs, alcohol and tobacco
are dangerous in pregnancy...
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Pregnancy, whether planned or surprise, brings with it important
concerns about prescription and over the counter drugs as well as
illegal drugs. Not every drug is a risk to the fetus but many are.
Taking drugs whether legal or illegal, drinking alcohol and smoking
while pregnant is risky.
A woman who drinks, smokes or takes drugs during pregnancy is
risking her baby’s life.
Interaction – What things/drugs that a pregnant women takes might
cause problems for the baby? What sorts of problems might you
expect?
(Suggestion: Have bottles of aspirin, and other over counter meds.
Ask: Which of these might be harmful to the fetus. Answer: All could
be harmful. Ask your health care provider before taking any type of
medicines).
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Accutane in Pregnancy
This sign means
DO NOT take this
drug if you are,
or could be
pregnant
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One example of a prescription drug that can have serious effects on a
baby is Accutane.
Accutane, which is often used to treat acne, can cause significant
damage to babies if the mother takes it during pregnancy. The woman
may either not know she is pregnant or fail to tell the doctor, who
prescribed the drug, that she is pregnant.
Babies exposed to Accutane may have malformed ears. In some
cases, they do not have any ear canals at all, resulting in deafness.
The jaw may be deformed causing great difficulty sucking so feeding
and weight gain are additional problems. There can also be problems
with the central nervous system, deformities of the skull and face, heart
and blood vessels, and the liver.
Because some drugs can cause birth defects and we don’t always know
which ones yet, pregnant women should be careful about all
medications in pregnancy.
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Talk to your care provider before
taking any over the counter
medications during pregnancy
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When a woman is pregnant she should not take over the
counter drugs, like aspirin, Tylenol, Advil, cough or cold
medicine, herbs or “natural” remedies without first asking the
nurse or doctor. Even medicines you can buy without a
prescription can pose a risk to the unborn baby.
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Many substances are harmful in
pregnancy
Energy drinks may contain
Caffeine (typically the amount in 2.5 Cokes)
Ephedrine (stimulant)
Siberian Ginseng (stimulant)
Green Tea (caffeine)
Echinacea (herb)
Ginkgo Biloba (herb)
St. John's Wort (antidepressant)
Kava Kava (traditional Polynesian sedative)
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Many other substances can be harmful in pregnancy.
Caffeine, certain herbs and chemicals can all cause damage to
a developing fetus.
Pregnancy is a time when we care for ourselves and our
babies. A pregnant woman must choose wisely what she puts
in her body. The consequences can be permanent.
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Drugs, smoking & alcohol can
cause Premature Birth
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Using drugs, alcohol and tobacco during pregnancy is one of
the causes of premature birth and low birth weight. Preterm
birth is defined as a live birth before 37 completed weeks. The
babies shown above were born prematurely, some earlier than
others. These babies were born weeks or months before they
should have been.
Because of this they can suffer many problems including brain
bleeds, respiratory infections, heart problems, hearing loss,
blindness and many other conditions.
They can spend months in the hospital before they are ready
to go home, if they survive.
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Baby born with Gastroschisis
(Gastro-skee-sis)
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Drugs, alcohol and smoking can also contribute to birth
defects. One example, gastroschisis (gastro-ski-sis), is a birth
defect in which the baby’s intestines and/or liver develop
outside of the baby’s body. Cocaine and other stimulant drugs
used during pregnancy can cause this defect.
Ask: Who is under the age of 24? You all have one risk factor
for having a child with gastroschisis.
Gastroschisis is most common in women under 24 and in
those who take illegal drugs. Some babies can be helped with
surgery but some (12 %) of babies born with gastroschisis die
at birth.
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Illegal Drugs in Pregnancy
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In addition to the risks of low birth weight, prematurity, birth
defects and developmental disabilities, babies whose mothers
take illegal drugs while pregnant may be born addicted and
suffer from withdrawal. These babies are agitated and
irritable, difficult to relax and unable to suck. Withdrawal can
be so severe that the babies need medication after birth.
Even if a woman stops taking drugs before the baby is born,
her child can have severe birth defects.
Stopping is the best treatment. Better late than never!
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Marijuana in Pregnancy
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Ask: Is it safe to smoke pot during pregnancy?
Pot and pregnancy don’t mix. Marijuana use can reduce
fertility in both men and women, making it difficult to conceive.
If you are pregnant, you need to know that marijuana crosses
the placenta and can affect your baby. Marijuana use during
pregnancy has been linked to low birth weight in the baby and
withdrawal-like symptoms including excessive crying, and
tremors (shaking). Some studies suggest that children
exposed to marijuana while in the womb are at increased risk
of attention disorders and learning problems later in life.
http://www.marchofdimes.com/pnhec/159_4427.asp
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Smoking in Pregnancy
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Smoking in general is harmful to everyone. Women, who are pregnant, are
especially at risk because they are responsible for two lives: theirs and their
baby’s. Women should avoid smoking while they are pregnant, and other
people should not smoke when they are near pregnant women. It is
important to avoid 2nd hand smoke.
Tobacco smoke contains more than 2500 chemicals including ammonia,
benzene, formaldehyde and arsenic. Many of these items are known as
familiar household cleaning products. (Suggestion for props: Show bottles
of household cleaners—Would you like to ingest this? Poor into empty baby
bottle for dramatic effect. Point: When you smoke your baby is also getting all
these chemicals).
Smoking nearly doubles a woman’s risk of having a low-birthweight baby.
Low birthweight can result from poor growth before birth, preterm delivery or
a combination of both. Smoking may also cause other complications in
pregnancy that can be dangerous to the mother and baby.
However, the good news is that if a woman quits smoking by the end of the
first trimester of pregnancy, the risk of low birthweight is no higher than a
non-smoking woman.
After birth, babies whose parents smoke also have a higher rate of chest
colds, bronchitis and pneumonia than babies with non-smoking parents.
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Alcohol in Pregnancy
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Drinking while pregnant is just like feeding your baby alcohol in
its bottle. Alcohol in the mother goes directly to the developing
baby and alcohol stays in the baby’s system longer than the
mother’s system.
Alcohol can cause many problems including birth defects.
One in 250 babies born in the US are damaged by alcohol.
There is no way to tell how much is safe. Babies born to
mothers who had one night of heavy drinking while pregnant
may be affected as well as babies whose mothers drank
frequently throughout their pregnancy.
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Fetal Alcohol Syndrome
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Fetal Alcohol Syndrome affects many children whose mothers
drank alcohol during pregnancy. These babies are born small
at birth and may have distinctive facial features, including a
flattened area between the nose and lip, narrow upper lip,
small eyes, narrow forehead and a small head.
These children also suffer from mild to severe mental
retardation.
Children with Fetal Alcohol Effect (fetal alcohol spectrum
disorder), a milder disease than FAS, may not have facial
changes, but their brain is affected. They may have trouble
with school work and social relationships.
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Heavy alcohol consumption can decrease brain size. This top
picture is a view of two human brains. One is a normal infant
brain at 6 weeks. The one on the right is a view of an infant
with fetal alcohol syndrome. You can see that the fetal alcohol
brain is smaller and looks irregular. The folds in the brain
tissue are different than the normal brain.
In the second picture you can see that a baby’s brain can be
affected by alcohol without causing changes in her
appearance. Some effects of alcohol do not show up until a
child is much older and enters school.
No amount of alcohol is safe in pregnancy!
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Premature Babies are at Risk for
Many Health Problems
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Ask: When you think of premature babies, what are some
words that come to mind? Do you know anyone who has had
a premature baby? What types of problems did the baby
have?
Although drug and alcohol use are one thing that may increase
the risk of premature birth, often doctors don’t know exactly
why a baby is born prematurely.
Babies born too soon are often born too small. But these
premature infants are not just small - many organs are not fully
developed when they are born and they are at risk for many
health problems including long term breathing problems, heart
problems, cerebral palsy, and developmental disabilities. They
need special care in the hospital and may not be able to go
home for many weeks or months. Very premature and small
babies may not survive.
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Who is at risk for preterm birth?
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Ask: What conditions put a mother at risk for preterm birth?
Interaction: Write ideas on blackboard.
A woman is at high risk for preterm delivery if she has had
pervious preterm birth, is pregnant with twins or triplets (or
more) or has certain uterine or cervical abnormalities.
Other factors besides smoking, alcohol or illegal drug use also
increase the risk of preterm birth including: being a teenage
mom, being older than 35, getting late or no prenatal care,
domestic violence, lack of social support and working long
hours with long periods of standing.
Certain medical conditions can also increase the risk of
prematurity – infections, diabetes, high blood pressure, being
underweight or obese before pregnancy, and having a short
time between pregnancies.
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Cerebral Palsy
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These children have cerebral palsy, a condition in which a
person’s muscles do not work properly and they may not be
able to walk or feed themselves. Many cases of cerebral palsy
are caused by premature birth or maternal infections that lead
to brain injury in the baby.
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Prenatal Care
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Ask: What is prenatal care? Why is prenatal care important? What are
some reasons why a woman might not get prenatal care in the 1st 3
months of pregnancy? How could she deal with these ‘obstacles’?
It is very important for women to get prenatal care from a doctor,
midwife or nurse beginning in the first 3 months of pregnancy.
The provider will teach their patients about pregnancy, answer
questions that the women or her partner may have and check for
infections or health problems that could affect the mom or baby. They
will monitor the pregnancy to make sure that everything is going well.
If there are any problems, the provider can take the next steps to deal
with the problems appropriately.
Note: In Washington: Healthy Mothers, Healthy Babies is an
organization offering resources for prenatal care and support for mom
and or dad.
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Sexually Transmitted Infections
Eye infection in newborn
from Chlamydia
Congenital systemic
herpes infection
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Ask: What are some STIs? How does a person get an STI? What
risks do STIs have on babies? How can you prevent harm to your
baby?
Sexually transmitted infections can cause miscarriage, tubal pregnancy,
premature birth, stillbirth, birth defects and newborn illness and death.
It is important for a pregnant woman to find out if she has an STD so
that she and her baby can be treated properly
In the picture on the right, you can see a baby with a herpes infection. In
the adults, genital herpes can cause painful itch blisters in the genital
area, but many women who have herpes do not have any symptoms. A
small number of women with herpes can pass it on to their infants. The
risk of passing it along to the infant is highest if the woman gets herpes
while she is pregnant. If the infant becomes infected with herpes, it can
cause a very serious infection that can lead to brain damage, blindness,
hearing loss, liver damage, and developmental disabilities in the baby.
The baby on the left has an eye infection from Chlamydia, which is
passed to the baby as it travels through the birth canal.
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Sexually Transmitted Infections
Disease
Effects
Treatment
Chlamydia
Miscarriage, premature birth,
pneumonia or eye infection in
the baby
Antibiotics can cure Chlamydia
Gonorrhea
Miscarriage, premature birth,
eye, joint or blood infections
in baby
Antibiotics can cure Gonorrhea
Syphilis
Fetal or infant death, brain
damage, blindness, hearing
loss
Antibiotics can cure, and baby
usually won’t be affected if treated
by 4th month of pregnancy
Genital
Herpes
Skin sores, severe infection
can cause brain damage,
blindness, hearing loss and
mental retardation in baby
No cure, but medicines can treat
sores. Doctors can do c-section if
there are vaginal sores at time of
delivery
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Briefly describe table: disease, effects and treatment.
At an early prenatal visit a woman should be offered screening
for certain STIs, such as HIV (the virus that causes AIDS),
chlamydia, gonorrhea, hepatitis and syphilis.
The best way to avoid becoming infected with STIs prior to or
during pregnancy is to abstain from sex, use a condom, limit
your number of sexual partners and/or maintain a
monogamous relationship. The best way to avoid injury to the
unborn child is to get tested for STIs and to let your provider
know about any genital infections or sores that you have had
in the past so that you and your baby can be treated
appropriately.
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HIV
• Women who learn that
they carry the virus
can get treatment for
HIV
• Treatment with
antiviral medication
dramatically reduces
the chance that she
will pass HIV on to her
babies
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120,000-160,000 women in the United States are living with
HIV. The CDC and the March of Dimes recommend that all
pregnant women be offered counseling and testing for HIV.
Women who learn they carry the virus can get treatment for
HIV to help protect themselves and their babies.
New antiviral treatments can reduce the chance of passing
HIV from a mother to child to less than 2%. Without treatment,
the risk of passing HIV from a mother who is infected to her
baby is 25%.
HIV testing is offered at prenatal care. Many teenage cases
are picked up for the first time at prenatal screening.
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Baby at 30 weeks gestation
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This is a picture of a baby at 30 weeks gestation… 2 months
away from a normal full term birth. Around the baby, you can
see the umbilical cord; this is what brings the nutrients to the
baby from the mother.
The baby doesn’t eat like you and I do at this state, but relies
on the mother for vitamins, minerals and calories to grow.
So what the mom eats, or doesn’t eat, impacts the baby.
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Anorexia and Pregnancy
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This is a picture of a baby born to a woman who has anorexia,
an eating disorder where the woman restricts what she eats or
excessively exercises. The woman did not gain enough weight
during pregnancy to provide enough nutrition for both herself
and her baby.
Ask: How many pounds should the average woman gain
during pregnancy? (25-35 lbs.)
Because she didn’t gain weight, her baby did not gain weight
either. As you can tell, this baby has very little fat on it’s body.
It may have permanent problems including poor brain
development due to the lack of nutrition.
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Nutrition
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Women should eat healthy foods like fruits and vegetables,
low-fat protein and whole grains and limit fats and sweets
during pregnancy. Pregnancy is not a time for radical diets or
“low-carb” experiments.
Exercise is also healthy for mothers and babies! The difficulty
and level of activity can be modified as the pregnancy
progresses and the baby gets bigger.
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Foods in
Pregnancy
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However, there are a few things that pregnant women should avoid
eating due to risk of infection or injury to her unborn child.
Make sure that all meats and eggs are fully cooked to avoid bacterial
infection (this means no raw cookie dough or runny eggs).
Raw fish or sushi can also be harmful.
Some deep sea fish contain high levels of mercury (that can affect brain
development) so pregnant women shouldn’t eat shark, mackerel,
swordfish and tilefish at all and they shouldn’t eat more than 6 oz per
week of white tuna or tuna steak. The EPA/FDA recommends that a
pregnant woman can eat up to 12 oz per week of other seafood that is
lower in mercury.
Soft, unpasturized cheese, packaged meat and deli meat can cause a
form of food poisoning (listeriosis) that is especially dangerous during
pregnancy. Pregnant women can protect themselves by avoiding hot
dogs, smoked meats and deli meats unless they are reheated until
steaming hot.
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Eating properly before and during pregnancy is very important. There
are certain vitamins and minerals that are necessary for a healthy baby.
Ask: What do you think is the most important vitamin to take?
One particularly important vitamin is Folic Acid (or folate). It is
recommended that all women of childbearing age take a multi-vitamin
with 400 micrograms of folic acid every day.
Ask: What kind of birth defects do you think are prevented by taking this
vitamin? When should you start taking it?
Folic acid also protects against certain birth defects of the brain and
spine.
Dried beans and legumes, oranges and orange juice, peanuts and leafy
green vegetables all contain folate. Synthetic (manufactured) folic acid
is added to grain products, including flour, rice, pasta, cornmeal, bread
and cereals. These foods are considered “fortified” with folic acid.
Potential interaction – pass out 3 or 4 different types of vitamins and
have students find the one with 400+ mcg of folate.
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Spina Bifida
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A lack of folic acid during pregnancy can cause serious birth
defects such as spina bifida. Spina bifida happens when the
spine fails to close during the first 22 days of pregnancy.
That’s right! The spine is formed by day 22 of pregnancy. As
you can see, there is a hole in the sac covering the spinal cord
and a defect in the bony spine in the same area. This effects
the child’s nervous system. It can cause problems with the
child’s ability to use his legs go to the bathroom normally.
Taking a multi-vitamin with folate everyday before pregnancy
can help prevent spina bifida. If a woman waits to take
vitamins until after she knows she’s pregnant, it may be too
late to prevent this birth defect!
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Dad’s Responsibilities
Help your partner make healthy choices:
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5
5
5
5
5
5
5
Avoid Alcohol
Avoid tobacco smoke
Eat nutritious foods
Avoid unsafe drugs
Don’t let her clean the cat litter box
Avoid dangerous household products
Remind her to take vitamins with folate
Make sure she gets prenatal care
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Fathers are a very important support for their pregnant partners. They
can do many things to help their partners stay healthy and have a
healthy baby. Ask: What can fathers and friends do to encourage
healthy pregnancy?
•Dads can help their partner avoid alcohol, and could even consider
avoiding alcohol themselves to help mom stay away from alcohol.
•They should stop smoking, second hand smoke isn’t good for the
mother or the baby.
•Help mom eat healthy foods and avoid risky foods
•Help her avoid unsafe drugs and medications
•They should take over cleaning the cat’s litter box, and help her avoid
other cat feces to avoid exposure to toxoplasmosis – an infection that
can cause serious problems for a developing baby
•They can also make sure that she stays away from dangerous
household products like paint, paint thinner, solvents and pesticides..
•They can help her to remember to take a multivitamin with folate before
she becomes pregnant and can make sure that she gets good, timely
prenatal care.
•Note: Friends are an important support system and can participate in
these same tasks.
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Make wise choices now for a
healthy baby later
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The lifestyle and health-related choices a young woman
makes now effect not only her present health, but also her
long-term health and the health of the children she may have
sometime in the future. Habits, good or bad, are hard to
break.
Make wise choices now. The health of your future children
may depend on it.
Wrapping up the session: Do you have any questions?
And now for the exam/quiz – provide prizes/candy for
completing and returning quiz and survey.
Please let us know how we did and fill out this survey.
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