Birth defects affect one in every 33 babies (about 3% of all babies) born in the United States each year. While it’s hard to imagine a time when physicians were unaware of the correlation between a mother’s actions and the health of her unborn baby, it existed and not too long ago.
Mark Hudak, MD, chief of neonatology at UF Health Jacksonville, explained that in 1957 a drug called thalidomide was first marketed in West Germany to cure anxiety and insomnia. Afterwards, the drug was used to combat morning sickness in pregnant women. Shortly after the drug started being used for this purpose, thousands of infants were born with phocomelia, a congenital disorder involving malformation of the limbs.
“We began seeing babies with this very distinctive defect where they had shortened limbs with absent fingers and absent toes,” Hudak said. “Two and two were put together, and it was recognized that thalidomide caused birth defects.”
This connection resulted in the strengthening of laws that led to the U.S. Food and Drug Administration having authority to regulate drugs, which now have to be both effective and safe.
“Before that time, people really didn’t think there was anything that a mother could eat or be exposed to that would cause birth defects in the womb,” Hudak explained. “They thought the womb was a very protective environment that insulated the fetus from any harm.”
Fetal Alcohol Spectrum Disorders
Prescription drugs aren’t the only substances with the potential to harm an unborn child. Hudak made note that the number one drug that has the highest total morbidity or impairment rate in babies is alcohol.
“Exposure to alcohol, in a dose-dependent way, will have effects on babies,” Hudak said. “You can have anything from the fetal alcohol syndrome to the fetal alcohol effect.”
The fetal alcohol effect is where you don’t necessarily see the changes in the baby’s face, but the baby has suffered some neurological disability or a failure to reach the maximum potential for the brain to develop. This could lead to the child having learning disorders or mental retardation.
The first trimester is a critical time for fetus development. Once you learn you are pregnant, it’s imperative to stop consuming alcohol. When a woman drinks alcohol while pregnant, the alcohol passes to the baby through the bloodstream, harming the unborn child.
Some studies have suggested that small amounts of alcohol are acceptable, but Hudak believes that any amount of alcohol is harmful during pregnancy. “I think pregnant women are advised to not drink.”
Another drug Hudak stressed the importance of avoiding while pregnant was isotretinoin, commonly known as Accutane, which is used to treat nodular acne. The FDA started iPLEDGE, a campaign to educate women on the effect Accutane can have on their bodies. The campaign stresses two main points:
1. Do not take isotretinoin if you are pregnant.
2. Do not get pregnant before starting isotretinoin, while taking it, and for one month after your last dose.
Benefits of Folic Acid
In addition to avoiding drugs that are known to cause birth defects, alcohol and street drugs, Hudak advises women to take 400 mg of folic acid before becoming pregnant and for the first 28 days after conception.
“If you take your 400 mg of folic acid every day before becoming pregnant, you reduce your risk of having a baby with spina bifida by as much as 70 percent,” Hudak explained. Spina bifida is a condition that affects the spine and might cause physical and intellectual disabilities.
UF Health Obstetrics and Gynecology – Jacksonville has a long tradition of excellence with experts in every area of women's health. To learn more about the services we offer, visit UFHealthJax.org/obstetrics-gynecology or call 904-633-0411.
Chair, Department of Pediatrics; Chief, Division of Neonatology; Associate Medical Director NICU Wolfson Children's Hospital; Associate Dean for Managed Care