Regardless of how deeply a mother cares for her unborn child, there's no guarantee it will be born in perfect health. Birth defects are more common than you may think, and they’re not always avoidable.
According to the National Birth Defects Prevention Network (NBDPN), 1 in 33 infants in the United States is born with a birth defect. “Although genetics play a role, the causes of most birth defects remain a mystery,” the group says.
There are simple steps a woman can follow to increase the odds of birthing a healthy baby. That's the message the NBDPN wants women, their partners, and health-care providers to heed. 
"We educate women about having a healthy pregnancy to prevent birth defects," said Denise Higgins (chairwoman of the NBDPN’s education and outreach committee).
Women are advised to take folic acid at least a month before planning on getting pregnant. Folic acid (folate) is a B vitamin necessary for proper cell growth. Studies show it can decrease the risk for neural tube birth defects, including spina bifida (a leading cause of childhood paralysis) and anencephaly (a fatal condition in which parts of the brain and skull cap are missing).
According to the March of Dimes, about 2,200 babies in the United States are born with neural tube defects each year.
It's important to get enough folic acid before getting pregnant because the neural tube (the part of the embryo that becomes the brain and spinal cord) develops in the first couple weeks of pregnancy. A survey conducted by the March of Dimes in 2004 reported that forty percent of childbearing age American women are now getting enough of the vitamin to help prevent birth defects. That's up from 32 percent the previous year. Although this constitutes a sharp increase, it’s far from the majority.
The National Council on Folic Acid has launched National Folic Acid Awareness Week to make people aware of the many benefits this vitamin has.
The U.S. Public Health Service urges all women of childbearing age to take a multivitamin containing 400 micrograms of folic acid every day. According to the U.S. Centers for Disease Control and Prevention, folic acid pills and most multivitamins sold in the United States have 100 percent of the daily value of folic acid. However, women should read the labels to be certain.
“Women who have previously had a child with a neural tube defect need even more folate. They require 4 milligrams daily before conceiving as well as during their pregnancy,” says Dr. Diane Ashton (associate medical director of the March of Dimes).
Women should also abstain from drinking alcohol at any time during pregnancy. Alcohol can cause fetal alcohol syndrome (FAS), which is a lifelong condition characterized by abnormal facial features, growth retardation, and central nervous system problems. Children with FAS may have physical, mental, social, and behavioral problems.
“Up to 1 in 1,000 children born in the United States each year suffer from fetal alcohol syndrome,” the NBDPN says. Prenatal alcohol-related conditions, including alcohol-related neurodevelopmental disorder and alcohol-related birth defects, are believed to occur three times more than fetal alcohol syndrome,” the CDC notes.
"There's no healthy amount of alcohol a pregnant woman can drink," Higgins cautioned. "We don't know if one drink causes fetal alcohol syndrome or being an alcoholic does. Just don't drink."
“Studies show that even "social drinking" (a drink or two a week) may have adverse effects on the fetus,” Ashton said. Yet many women are not getting the message. "It's really important for their health-care provider to convey this to them," she said.
If you are pregnant, you will most likely have a simple blood test called an alpha fetoprotein (AFP) to screen for fetal abnormalities, including spina bifida and anencephaly. More invasive testing, including chorionic villus sampling and amniocentesis, is generally reserved for women 35 and older, or whose AFP results suggest a higher risk for birth defects.
Whether women under 35 should request invasive testing depends entirely on their preferences, said Miriam Kuppermann, an associate professor in the Department of Obstetrics, Gynecology and Reproductive Sciences at the University of California, San Francisco, who has studied the cost effectiveness of invasive testing.
"If interested, they should request clear information on how likely it is they are carrying an affected fetus and what the risks for miscarriage are, as well as other testing options," she said. Women who desire such testing should consult with a genetic counselor to review the risks and benefits.
If you're planning on getting pregnant, talk to your doctor about any health concerns you have. “Women with diabetes and epilepsy, for example, are at greater risk of having a baby with a neural tube defect,” Ashton said.
“Ask your doctor about any medications you are taking. Certain acne and seizure medicines have been linked to birth defects,” Higgins explained.
No one should have to suffer the heartache of having a child with a serious birth defect. Prenatal care experts encourage women to discuss any concerns they have with their health-care provider ahead of time.
"Preconception counseling is very important," Ashton said.
SOURCES: Denise Higgins, chairwoman, education and outreach committee, National Birth Defects Prevention Network, Helena, Mont.; Diane Ashton, M.D. M.P.H., associate medical director, March of Dimes, White Plains, N.Y., Miriam Kuppermann, Ph.D., M.P.H., associate professor, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco
