Most women of childbearing age have heard the long-touted advice regarding the importance of folic acid (a B vitamin) to a healthy pregnancy and baby. For decades, prenatal vitamins have been standard care for women hoping to become pregnant and those who already are. Yet, this is only a piece of the puzzle when it comes to preventing birth defects.

“All birth defects are not preventable, but appropriate management of health conditions and adoption of healthy behaviors can prevent many problems of pregnancy,” says Dr. Andrea Stephens, an obstetrician and gynecologist on staff at St. Luke’s Hospital. Taking a supplement containing at least 400 micrograms of folic acid can prevent 50 to 70 percent of neural tube defects, which are major birth defects of the brain and spine, such as spina bifida.

However, folic acid supplementation is not the only thing women should do to decrease the risk of birth defects. “Both alcohol and tobacco smoke have the potential to cause birth defects in pregnancy, so stopping alcohol intake and quitting smoking before pregnancy are important steps,” Stephens says.

Some medications and infections can cause birth defects, so women should visit their primary-care physician prior to pregnancy to ensure they’re current on immunizations and review medications, Stephens adds. Also, managing weight and diabetes is important since both obesity and poorly controlled diabetes are associated with preventable birth defects.

Despite the best efforts of women and their physicians, most birth defects occur very early in pregnancy and many are not preventable, notes Dr. Kimberly Martin, a SLUCare obstetrician and clinical geneticist. “Because spina bifida occurs before most women even find out they are pregnant, the extra folic acid must be taken every day for at least a month before she becomes pregnant,” she says.

And because about half of all pregnancies in the United States are unplanned, even among married women, Martin notes, all women of childbearing age should take the recommended amount of folic acid and control diabetes.

If a birth defect is detected through prenatal testing, families and physicians can prepare appropriately, says Dr. Michael Paul, an obstetrician on staff at Missouri Baptist Medical Center. “For parents who are expecting a child with birth defects, planning and recognizing the special needs of a child who will need special care as a newborn allows them to prepare psychologically and adjust their expectations,” he says.

Some birth defects are treatable before the baby is born, although this is an evolving and highly specialized medical field. “The treatment of most birth defects currently is undertaken after birth,” Paul says. “Many heart defects identified prenatally require early neonatal surgery to allow optimal potential for survival.”

Physicians agree that, although awareness of folic acid’s importance has resulted in fewer neural tube defects, women should talk with their physicians about what they need to do to help ensure a healthy pregnancy and baby.

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