pregnant and before taking any new medications
during pregnancy. The risk for teratogenic effects
may increase when a woman takes multiple med-
ications, even when those medications are preg-
nancy category A and B classifications.
Prenatal Care
PRENATAL CARE lowers the risk for many birth
defects. Folic acid (folate) supplementation signifi-
cantly reduces the risk forNEURAL TUBE DEFECTS
such as SPINA BIFIDAand also improves blood GLU-
COSE(sugar) control in women who have diabetes.
Doctors recommend folic acid supplementation
beginning before CONCEPTIONwhen possible, and
especially for women who are or have been taking
oral contraceptives (birth control pills), which
lower folic acid even further. Maternal blood tests
for rhesus (Rh) factor and ALPHA FETOPROTEIN(AFP),
ULTRASOUND, and in utero diagnostic procedures
such as CHORIONIC VILLI SAMPLING(cvs) and AMNIO-
CENTESIScan detect many birth defects before birth,
allowing the mother and her health-care provider
to make decisions and appropriate preparations.
Other prevention efforts target educating women
of childbearing age about the benefits of folic acid
supplementation and prenatal care, as well as the
risks of behaviors such as alcohol consumption
during pregnancy.
KEY MEASURES FOR PREVENTING BIRTH DEFECTS- folic acid supplementation for all women of childbearing
age, whether or not they are pregnant or planning PREG-
NANCY - comprehensive PRENATAL CAREduring pregnancy
- no alcohol consumption during pregnancy or when
attempting to conceive - vaccination before pregnancy for RUBELLA, CHICKENPOX,
MEASLES - GENETIC COUNSELINGwhen known hereditary conditions exist
in either parent or a previous child was born with birth
defects
See also ABORTION; CEREBRAL PALSY; CHROMOSOMAL
DISORDERS; CLEFT PALATE/CLEFT PALATE AND LIP; CON-
GENITAL ANOMALY; GENETIC DISORDERS; INHERITANCE
PATTERNS.building-related illness A health condition that
arises as the result of problems within a structure,
such as an office, school, or home. The US Envi-
ronmental Protection Agency (EPA) defines a
building-related illness (also called a BRI) as one
that- causes clinically observable symptoms and
signs, such as COUGH and FEVER, that extend
12 Preventive Medicine
Medication Taken to Treat Kinds of Birth Defects
angiotensin II receptor antagonist hypertension heart malformations, kidney deformities or
medications (losartan, valsartan, absence of kidneys, widespread organ
candesartan, irbesartan) damage
risk highest in third trimester
cimetidine (Tagamet) GASTROESOPHAGEAL REFLUX DISORDER NEURAL TUBE DEFECTS
(GERD), PEPTIC ULCER DISEASE
phenytoin (Dilantin) SEIZURE DISORDERS constellation of birth defects commonly
referred to as fetal phenytoin syndrome
craniofacial anomalies, deformities of the
hands and feet, rib deformities
sulfasalazine (Azulfidine) INFLAMMATORY BOWEL DISEASE(IBD), neural tube defects
especially ulcerative COLITIS
valproic acid (Depakene) seizure disorders craniofacial anomalies, spinal deformities