Increase Your Chances of Having a Healthy Baby

As an expectant mom, you want to keep yourself and your baby healthy. You especially want to protect against birth defects, which starts with regular prenatal care, says Georges Sylvestre, M.D., Assistant Professor of Clinical Obstetrics and Gynecology. “The ideal time to seek prenatal care is before you become pregnant,” Dr. Sylvestre says.

What are birth defects?

Birth defects are physical or genetic abnormalities that range from mild to severe, and may affect how your baby’s body looks, functions, or both. They can develop at any stage of pregnancy, although most occur during the first three months, as a baby’s organs form. Some birth defects, like Down syndrome, are detectable during pregnancy, while others, like cleft lip, don’t appear until birth. Although cleft lip is an easily recognizable birth defect, heart problems and hearing loss require special tests to diagnose.

What causes birth defects?

Medical science doesn’t fully understand what causes birth defects, although certain factors like poor underlying health, certain medications, environmental exposures, and genetics play a role, Dr. Sylvestre says. “The most common risk factor is taking medication while you're pregnant to control hypertension, diabetes, or depression and anxiety. Women who are actively trying to get pregnant should consult their physician first, especially when they have an underlying condition.”

Uncontrolled diabetes is another major cause of birth defects. “A woman who has uncontrolled diabetes has a 10% to 15% risk of having a baby with a serious heart or spinal defect,” Dr. Sylvestre adds. “If we can control the diabetes before she becomes pregnant, we can bring down those risks.”

Other factors that may increase your risk of having a baby with birth defects:

• Smoking, drinking alcohol, or using drugs during pregnancy.
• Having a family history of birth defects.
• Contracting certain infections during pregnancy, like Zika virus, cytomegalovirus, or syphilis, an easy-to-treat sexually transmitted infection.
• Experiencing a fever over 101F during pregnancy, or an elevated body temperature due to heat exposure.
• Conceiving when you are older than 35 years, when the risk of chromosomal abnormality increases. If you conceive at age 25, your risk of having a child with Down syndrome is about 1 in 1,250 but jumps to 1 in 100 if you conceive at age 40. 

Of course, you could have one or more of these risks and not have a baby with a birth defect. Or, you could have none of these risks and have a baby with a birth defect. Also, if you are an older mother or have a family history of birth defects, then you may want to consult a genetic counselor before conceiving. You may also want to talk to your doctor about how to lower your risk.

Early detection

You may request screenings like maternal blood tests and ultrasounds that can identify fetal birth defects or genetic disorders while you are pregnant. “Early in pregnancy, we screen for infections like syphilis, sometimes toxoplasmosis. Sometimes treating those infections in early pregnancy can reduce the risk of birth defects,” Dr. Sylvestre says.

Additionally, most pregnant women have two sonograms: one at the end of the first trimester, and another at 18-20 weeks. “Women who are of advanced maternal age, have taken toxic medication, or used drugs, alcohol, or marijuana, should be screened specifically with an early anatomy sonogram at 18 to 20 weeks,” he add.

If screening identifies an abnormality, or if your pregnancy is considered high risk, then your doctor will likely recommend a diagnostic test, including:

• Fetal echocardiogram. An ultrasound of a baby’s heart. 
• Fetal MRI. Imaging of potential brain or nervous system defects.
• Chorionic villus sampling. Tests for chromosomal or genetic disorders. 
• Amniocentesis. Tests for chromosomal disorders and genetic problems like cystic fibrosis or Tay-Sachs disease, plus certain infections such as cytomegalovirus (CMV).

Lower your risk

Not all birth defects are preventable, but you can improve your chances of having a healthy baby by:

• Seeing your healthcare provider regularly and starting prenatal care as soon as you think you might be pregnant.
• Avoiding  alcohol, cigarettes, marijuana, and other drugs.
• Consuming 400 micrograms (mcg) of  folic acid  daily. You can get folic acid from fortified foods or supplements, and a diet rich in folate.  “Taking folic acid three to four months before becoming pregnant has been shown to reduce the incidence of neural tube defects like spinal bifida or anencephaly, which is absence of the brain,” Dr. Sylvestre says.
• Consulting your healthcare provider about any  medications  that you are taking or considering taking, including those for anxiety or depression. “It's best not to take any of these meds, but sometimes you don't have a choice. So, with your physician you can choose the medication which is safest in pregnancy.”
• Talking to your healthcare provider about vaccinations.  Most vaccines are safe during pregnancy, including those for COVID-19. “Let's not forget that rubella and chickenpox are common infections that can cause birth defects,” Dr. Sylvestre says. “If you're not vaccinated and catch rubella, the chance of birth defects is significant. Know your status and get your vaccines up-to-date.” Learn about vaccinations during pregnancy and COVID-19 vaccines while pregnant or breastfeeding.
• Preventing or treating infections.
• Washing your hands. “If you work in healthcare or a daycare center, cytomegalovirus (CMV) is common and one of the most common causes of congenital deafness.”
• Immediately treating a fever when you’re ill or after getting a vaccine, and avoiding hot tubs, saunas, or other environments that might cause you to overheat.
• Keeping diabetes under control before becoming pregnant.
• Lose weight. “Decreasing your BMI (body mass index) might actually decrease the rate of certain birth defects,” Dr. Sylvestre says.