Everyone expects a pregnancy to end with the delivery of a healthy, structurally normal baby. But really, if you have the slightest idea about the permutations involved in the fertilization of an egg and its development thereafter, you will consider every perfect birth a scientific miracle; the number of things that can go wrong are numerous and it is not unusual to notice one defect or other every now and then. Birth defects can range from something as mild- and actually welcome- like dimples, to easily managed occurrences like extra fingers and toes, to conditions incompatible with life like anencephaly, where the brain is absent.
Many theories have been propounded to explain some of these abnormalities; some have been proven and others are still in doubt. With all the advancements in the field of foetal medicine and embryology, many things still remain unknown about the processes involved in forming life. This hiatus in knowledge makes it difficult to predict which fetuses, under which conditions, conceived to which parents, will come out with an abnormality or birth defect.
What is true though, is that both genetic and environmental factors contribute to the outcome of a birth. We can do little to nothing about genetics, but we hold the environment in our control- and it must be noted that the environment has influence on genes. Exposure to toxic agents (including certain medicines), inadequate diet, unhealthy habits and pre-existing maternal illnesses are environmental factors that can affect the outcome of a pregnancy.
We discuss these environmental factors below;
Alcohol- Women who consume alcohol during pregnancy are putting their unborn babies at risk of numerous health problems. Foetal alcohol syndrome is the most dreaded foetal complication of maternal alcohol consumption: It is the leading cause of intellectual disability and produces characteristic facial abnormalities, including a small head, small eye opening, thin upper lip and a short nose.
There seems to be a linear relationship between the amount of alcohol consumed and the number and severity of symptoms. However, the threshold of consumption that results in foetal effects is not known and it is therefore recommended that pregnant women avoid alcohol altogether.
Smoking and Illicit drugs- Tobacco smoke has been linked to birth defects like cleft lip and palate and is known to cause prematurity, still births and low birthweight babies. Smoking must be avoided during pregnancy and even second-hand smoking must also be avoided. Any amount of tobacco smoke can pose dire health consequences for both mother and baby. Illicit drugs like marijuana, methamphetamine, heroin and cocaine are also known to cause several birth defects and must all be avoided during pregnancy.
Folic acid – Folic acid (or folate) deficiency has been implicated in severe birth defects of the group known as neural tube defects- where there are abnormalities in the formation of the brain and/spinal cord and their coverings.
To prevent these defects there must be adequate levels of folate just prior to and throughout the pregnancy, especially in the first few weeks.
Folic acid is a B vitamin that is present in our diet, with high amounts found in cereals and legumes. Certain packaged cereals (e.g. some Quaker® Oats varieties) are also fortified to provide the full daily requirement of folate. It may be necessary to supplement with folate pills if the dietary source is inadequate.
Medication- Quite a number of medicines, even the seemingly harmless ones, are contra-indicated in pregnancy, especially in the first few weeks after conception. Some of these medicines are implicated in genital malformations, limb deformities and bone abnormalities. Women in their reproductive age, i.e. 15-45yrs, should thus avoid self-medication.
If you visit the clinic and you think there is the slightest chance you may be pregnant, inform your doctor (if he doesn’t ask you first) so the appropriate drugs are selected for your treatment. Commonly (ab)used drugs like antibiotics (e.g. amoxicillin, ciprofloxacin, penicillin), analgesics (e.g. ibuprofen, indomethacin, diclofenac), antimalarials and oral steroids, should be taken only upon the advice of a qualified healthcare professional.
Pre-existing illness- Certain medical conditions present a unique problem for pregnancy. A case in point is Diabetes Mellitus- Diabetes in itself can cause foetal abnormalities if not managed well. Also, some of the medications used to manage diabetes are known to be teratogenic (that is they can cause foetal malformations).
As such when a woman with diabetes plans to conceive, it is important she informs her doctor so that the most appropriate drugs are selected to manage the condition; the drugs selected will be potent for the mother, but safe for the baby. The same should be done for all other chronic illnesses that are present before conception.
The critical period for the occurrence of birth defects is the first few weeks after conception, when most women are not even aware they are pregnant.
This means that every sexually active woman of reproductive potential, especially those who are trying to conceive, should avoid alcohol, tobacco smoke, illicit drugs and self-medication.
They should also make sure all pre-existing illnesses are under control and remember to eat a healthy diet that provides enough folate and/or supplement with folate pills. We can leave genetics to fate and chance, but we cannot afford to take chances with things in our control. When it comes to baby, we want the best outcome after nine months of waiting.
By: K.T. Nimako (MB ChB)
Dr. Kojo Nimako is a private medical practitioner with an interest in public health and Citi FM’s Chief Medical Correspondent. He is also the Executive Director of Helping Hand Medical Outreach, an NGO focused on health education.
E-mail: [email protected]