March of Dimes

FOLIC ACID SAVES 1,300 BABIES EACH YEAR FROM SERIOUS BIRTH DEFECTS OF BRAIN AND SPINE

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Fortifying grain foods with the B vitamin folic acid has saved about 1,300 babies every year from being born with serious birth defects of the brain and spine known as neural tube defects (NTDs), according to new data published by the US Centers for Disease Control and Prevention in its publication Morbidity and MortalityWeekly Report (MMWR).The number of babies born in the United States with these conditions has declined by 35 percent since 1998.

About 3,000 pregnancies in the U.S. still are affected by NTDs annually. The March of Dimes says that even with fortified grain products, many women still may not be getting enough folic acid. The organization urges all women to take vitamins containing folic acid, but only about one-third of women do.

“All women capable of having a baby should be taking a multivitamin containing folic acid every day,” advises Siobhan M. Dolan, M.D., MPH, coauthor of the first March of Dimes book Healthy Mom, Healthy Baby: The Ultimate Pregnancy Guide. “It’s also good to eat foods that contain folate, the natural form of folic acid, including lentils, green leafy vegetables, black beans, and orange juice, as well as foods fortified with folic acid, such as bread and pasta, and enriched cereals.”

Since folic acid fortification went into effect in 1998, the percentage of babies born with NTDs declined by 35 percent, according to the CDC analysis in the paper “Updated Neural Tube Defect Prevalence Estimates after Mandatory Folic Acid Fortification – United States, 1995-2011,” published in today’s MMWR. A separate paper, “Supplement Use and Other Characteristics among Pregnant Women with a Previous Neural Tube Defect-Affected Pregnancy–United States, 1997-2009,” also published today in the MMWR, found that among women who had a prior baby born with an NTD those who took high-dose folic acid (4 milligrams) with a subsequent pregnancy were less likely to have a baby with an NTD than those who did not take folic acid. The papers are available at http://www.cdc.gov/mmwr

The authors urge women who had a previous pregnancy affected by an NTD to follow CDC recommendations to take high-dose folic acid beginning at least four weeks before becoming pregnant and continuing through the first trimester of pregnancy

Hispanic women continue to be about 20 percent more likely to have a child with an NTD than non-Hispanic white women, according to the new research. One reason may be that wheat flour is fortified with folic acid, but corn masa flour, more popular among Hispanic women, is not.

The March of Dimes and other organizations have petitioned the U.S. Food and Drug Administration to fortify corn masa flour with folic acid in the hope of lowering the rate of NTDs among Hispanics.

The March of Dimes is the leading nonprofit organization for pregnancy and baby health. For more than 75 years, moms and babies have benefited from March of Dimes research, education, vaccines, and breakthroughs. Find out how you can help prevent premature birth and birth defects by joining March for Babies at marchforbabies.org.

More than one in 10 babies worldwide born prematurely.

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Fifteen million babies, one in 10 births, are born prematurely every year, a global project suggests.

Baby in mother's arms in Nepal

One million of these babies die soon after birth. The joint report, led by the WHO, says three quarters of deaths could be prevented with basic care.

For the first time premature birth rates have been estimated by country, with the highest risk being in Africa.

In the UK about 8% of babies are born too soon and this rate is rising partly due to obesity and later motherhood.

There are nearly 60,000 premature births every year in the UK.

Andy Cole, from premature baby charity Bliss, said “it is worrying that the UK’s preterm birth rate is significantly higher than countries such as Sweden, Norway and Ireland, and highlights the need for well-co-ordinated and high-quality antenatal care for all women identified as high risk”.

“Start Quote

Being born too soon is an unrecognised killer”

Dr Joy Lawn Co-editor of the report

Worldwide problem

A premature or preterm baby is one that is born before 37 weeks after the first day of the mother’s last period. A full term baby is when pregnancy lasts 40 weeks.

Forty-four organisations contributed to The Born Too Soon report, which estimated premature birth rates – the number of babies born too soon, out of the total of number of live births – for 184 individual countries, in the first study of its kind.

Of the 11 countries where over 15% of babies are born too early, all but two are in sub-Saharan Africa. However, the report highlights it is a problem worldwide.

“It is very striking to see that preterm births have a similar burden all around the world – but due to different reasons,” Dr Lale Say from the WHO said.

“In developing countries it is due to things like infections, HIV, malaria and poor nutrition.

Baby in arms
Premature babies are likely to have developmental problems as they grow up

“In developed countries there are totally different risk factors – an older delivery age, diabetes, obesity and multiple births due to IVF.”

The report also mentions caesarean sections before full term, which are not always medically needed, as a reason for increasing premature baby rates.

A leading cause of death

Dr Joy Lawn, co-editor of the report and Director for Save the Children said: “This report shows the problem is much bigger than expected or realised. Being born too soon is an unrecognised killer.”

In children under five, prematurity is the leading cause of death worldwide, after pneumonia. Many premature babies that do survive develop learning difficulties and visual and hearing problems.

“This has been a shocker to those who work in child survival programmes – people were almost falling off their chairs when I reported back our findings,” said Dr Lawn.

“We have been working on problems identified 20 years ago. There has been progress in pneumonia, and diarrhoea as a cause of death has seen a major drop, but preterm birth has not been on anyone’s ‘to do’ list.”

“There is no excuse for 80% of babies, who are less than eight weeks early, to die – it’s lack of food and warmth, not lack of intensive care.”

Easy care

Experts at the UN say simple and inexpensive care, like antiseptic cream to prevent cord infection, one US dollar (60 pence) steroid injections given to mothers to help foetal lung development, and antibiotics to fight infection, can help keep premature babies alive.

They also advocate the use of kangaroo care – where the baby is tied, skin to skin, on the mothers’ front – which reduces infection, keeps the baby warm and makes it easy to breastfeed. This has been proven to dramatically reduce newborn death.

Not surprisingly, there are big inequalities in survival rates around the world.

Countries with the highest premature birth numbers (2010)

Source: World Health Organization

This is highlighted in the US – as, while it is makes the top ten for the highest number of premature births in the world, it is only number 37 for deaths – because of very effective and expensive intensive care.

Dr Christopher Howson, from March of Dimes, a baby charity which collaborated on the study said: “In low income countries, more than 90% of extremely preterm babies die within the first few days of life, while less than 10% die in high income countries.”

“However, this is a solvable problem. A number of countries, for example, Ecuador, Botswana, Turkey, Oman and Sri Lanka have halved their neonatal deaths from preterm birth through improving [care for] serious complications like infections and respiratory distress.”

It is hoped the report will spotlight premature births, especially in sub-Saharan Africa, and make it an urgent priority to help reach the UN Millennium Development Goal 4 set in 2000 – which calls for the reduction of young child deaths by two-thirds in 2015.

Map of premature birth rates across the world Premature birth rates across the world (2010)

Anti-Fungal Drug Not Tied to Most Birth Defects.

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Although some reports have shown that high doses of the anti-fungal drugfluconazole (Diflucan) may raise the risk of birth defects, a new Danish review finds that more commonly prescribed lower doses of the medicine do not carry the same dangers.

Yet, in spite of this reassurance, experts may remain reluctant to prescribe the drug for expectant mothers who have yeast infections, since it is still linked to an increased risk of a rare congenital heart problem called tetralogy of Fallot.

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“Many pregnant women suffer from a yeast infection called vaginal candidiasis, or vaginal thrush, which is the most common clinical indication for use of oral fluconazole,” explained lead researcher Ditte Molgaard-Nielsen, an epidemiologist at the Statens Serum Institute in Copenhagen.

First-line treatment for vaginal candidiasis during pregnancy is vaginal preparations of topical anti-fungal drugs, she noted.

“However, in cases when topical treatment is ineffective this study provides comprehensive safety information, and may help inform clinical decisions when treatment with oral fluconazole is considered in pregnancy,” Molgaard-Nielsen said.

Specifically, the researchers looked at 15 birth defects linked to fluconazole and found it was not associated with an increased risk for 14 of them, she said.

“However, we did see an increase in the risk of tetralogy of Fallot, an uncommon congenital heart defect, but the number of exposed cases were few and this association should be confirmed in other studies before anything can be concluded with any certainty,” Molgaard-Nielsen added.

The report was published Aug. 29 in the New England Journal of Medicine.

Dr. Scott Berns, senior vice president and deputy medical officer for the March of Dimes, said that “when pregnant it is important to avoid taking any medicines unnecessarily.”

“I would chose the topical drug to treat a yeast infection. That is my first line,” he said. “If I had to use oral fluconazole, this study is reassuring that most of the time the baby is going to be fine. But, there is that small chance of tetralogy of Fallot. So, why take that chance?”

Another expert doesn’t think these findings will change clinical practice.

“Ob/Gyns are still going to be reluctant to prescribe this drug,” said Dr. Kecia Gaither, director of maternal fetal medicine at Brookdale University Hospital and Medical Center in Brooklyn, N.Y.

Gaither prefers to use natural methods for treating yeast infections. “One of them is increasing the use of yogurt intake,” she said. “There is certain bacteria in yogurt that prevents yeast infections. I have not run into a person who continues to have recurrent yeast infections after that is done.”

For the study, Molgaard-Nielsen’s team collected data on more than 7,300 women who took fluconazole during their pregnancy, among whom 210 infants were born with birth defects, and compared them to a control group of more than 968,000 unexposed women, among whom more than 25,000 babies were born with birth defects.

In both groups, the risk for having an infant with a birth defect was 0.6 percent, the researchers found.

Moreover, fluconazole wasn’t linked to a significantly increased risk for 14 of 15 birth defects to which the drug had been previously linked, they added.

These include craniosynostosis (a defect in the baby’s skull), middle ear defects, cleft palate, cleft lip, limb defects, an abnormal number of finger or toes, fused fingers or toes, diaphragmatic hernia, heart defects and shifting of a lung.

There was, however, a significantly increased risk of tetralogy of Fallot, with seven cases (0.10 percent) among women who took fluconazole, compared with 287 cases (0.03 percent) in unexposed women, the researchers found.

According to the U.S. National Institutes of Health, tetralogy of Fallot is a rare, complex birth defect where four different areas of the heart are malformed and the heart cannot pump enough blood or oxygen to the rest of the body. Surgery is usually required shortly after birth, although the long-term outlook for these patients has improved greatly in recent years.

Source: Drugs.com