News Moms Need

Dr. Boyle of the CDC

Did you know that 1 in 33 babies born in the U.S. has a birth defect?

Most people don’t realize how common these conditions are. Every 4 ½ minutes, a baby is born in the United States with a major birth defect. These conditions are common, costly and critical.  In fact, birth defects are a leading cause of death in the first year of life.  And, for affected babies who survive and live with these conditions, birth defects increase the risk for long-term disabilities. Birth defects not only impact babies born with these conditions; they also have an emotional and financial impact on their families and communities.

The good news is that we’ve learned a lot about what might increase the risk for birth defects. For example, we know that taking certain medications, having uncontrolled diabetes, smoking cigarettes, or drinking alcohol during pregnancy can increase the risk for birth defects.  We also know that certain things, like consuming folic acid daily before and during early pregnancy, can reduce the risk for major birth defects.  The CDC continues to study the causes of birth defects, look for ways to prevent them, and work to improve the lives of people living with these conditions.

Each year, MOD and the CDC join many organizations to recognize January as National Birth Defects Prevention Month. Please join us for an online chat on what we’ve learned about preventing birth defects. We’ll highlight birth defects research over the years and provide tips for a healthy pregnancy. We hope you can join Dr. Colleen Boyle, Director of CDC’s National Center on Birth Defects and Developmental Disabilities, on Thursday, January 10, at 1PM EST. The hashtag is #1in33chat.

It’s important to remember that many birth defects happen very early during pregnancy, sometimes before a woman even knows she is pregnant, so planning a pregnancy and working to get healthy before becoming pregnant can make a difference.

Written By: Cynthia A. Moore, M.D., Ph.D. Director
Division of Birth Defects and Developmental Disabilities
National Center on Birth Defects and Developmental Disabilities
Centers for Disease Control and Prevention

Anifa is an 18-month-old girl who was born with spina bifida, a serious birth defect of the spine. Like many children with spina bifida, Anifa is paralyzed and has no bowel or bladder control. She lives with her family in a village in Nigeria where there is no primary health center to help her. As a result, Anifa could not have surgery to close the opening in her spine until she was nine months old. During this time, her spinal cord was exposed and without protection. In the U.S., the first surgery for a baby born with spina bifida usually takes place within the first 24 hours of life to avoid complications or death. But Anifa had no choice but to wait.

In the United States, children born with spina bifida often live long and productive lives, even though they face many challenges. In many other countries, however, the outlook for children like Anifa is not as positive.

The Centers for Disease Control and Prevention (CDC) first began researching folic acid’s role in preventing birth defects in the early 1980s. Early studies found the risk for having a baby with a neural tube defect (NTD), such as spina bifida, was reduced if the mother had taken folic acid before and during early pregnancy. As a result, U.S. Public Health Service released the 1992 recommendation that all women who could become pregnant should get 400 micrograms (mcg) of folic acid every day.

Women can get folic acid in three ways: diet, vitamin supplements, and flour fortification. Experts agreed that getting 400 mcg of folic acid from naturally-occurring food sources alone was impractical—women would have to eat a lot of folate-rich foods which are expensive and not readily available in many communities.

In January 1998, in response to requests from the CDC and its collaborators, including the March of Dimes, the FDA mandated fortification of cereal grain products labeled as enriched in the United States. “At that point, we had what we thought was the best possible coverage of women of child-bearing age to get folic acid for the prevention of neural tube defects,” says former CDC scientist Joe Mulinare. With a 36 percent reduction in the rates of neural tube defects by the end of 2006, folic acid fortification was recently named one of the Ten Great Public Health Achievements in the United States.

Folic Acid Awareness Week is January 6-12th, 2013. We are honored to have this guest post from the CDC. Author: Christina Kilgo, MA, Health Communication Specialist and SciMetrika contractor for CDC’s National Center on Birth Defects and Developmental Disabilities.

July is National Cleft and Craniofacial Awareness and Prevention Month. A cleft lip is a birth defect in which a baby’s upper lip doesn’t form completely and has an opening in it. A cleft palate is a similar birth defect in which a baby’s palate (roof of the mouth) doesn’t form completely and has an opening in it. These birth defects are called oral clefts.

Babies and children with oral clefts may have feeding problems, ear infections and hearing loss, speech problems and dental problems.

We’re not sure what causes oral clefts. Some possible causes are:
• Changes in your baby’s genes. Genes are part of your baby’s cells that store instructions for the way the body grows and works. They provide the basic plan for how your baby develops. Genes are passed from parents to children.
• Not getting enough folic acid before pregnancy. Folic acid is a vitamin that can help protect your baby from birth defects of the brain and spine called neural tube defects. It also may reduce the risk of oral clefts by about 25 percent.
• Taking certain medicines, like anti-seizure medicine, during pregnancy
• Smoking during pregnancy. Smoking causes 1 in 5 (20 percent) oral clefts.
• Drinking alcohol during pregnancy
• Having certain infections during pregnancy

Not all clefts can be prevented. But there are things you can do to help reduce your chances of having a baby with an oral cleft:
• Before pregnancy, get a preconception checkup. This is a medical checkup to help make sure you are healthy before you get pregnant.
• Before pregnancy, take a multivitamin with 400 micrograms of folic acid in it every day.
• During pregnancy, take a prenatal vitamin with 600 micrograms of folic acid in it every day.
• Talk to your provider to make sure any medicine you take is safe during pregnancy.
• Your provider may want to switch you to a different medicine that is safe during pregnancy.
• Don’t smoke.
• Don’t drink alcohol.
• Get early and regular prenatal care.

Nine months of a healthy pregnancy is the best gift you can give your future baby. There are things you can do before you get pregnant to help give your baby a better chance of a healthy and full-term birth. Talk to your health care provider before and during pregnancy about you and your partners’ health and any concerns you many have. This will help you have a healthy baby.

Before getting pregnant, ask your health provider these 9 questions.

What do I need to know about:
1. Diabetes, high blood pressure, infections or other health problems?
2. Medicines or home remedies?
3. Taking a multivitamin pill with folic acid in it each day?
4. Getting to a healthy weight before pregnancy?
5. Smoking, drinking alcohol and taking illegal drugs?
6. Unsafe chemicals or other things I should stay away from at home or at work?
7. Taking care of myself and lowering my stress?
8. How long to wait between pregnancies? (Ask your health care provider what’s best for you.)
9. My family history, including premature birth? Premature birth is when your baby is born too early, before 37 completed weeks of pregnancy.

Special thanks to the celebrities Thalia and Heather Headley for helping the March of Dimes tell women about these 9 important questions.

Did you know that Hispanic women are about 20 percent more likely to have a child with a neural tube defect (NTD), which includes spina bifida and anencephaly, than non-Hispanic white women?  Although the reasons for the disparity are not well understood, Hispanic women have been found to have lower intake of the B vitamin folic acid overall compared to non-Hispanic white women. 

Serious birth defects of the brain and spine in America’s babies, particularly those of Hispanic origin, could be reduced if the nation’s corn masa flour products were fortified with folic acid, according to a new petition filed with the U.S. Food and Drug Administration (FDA) by a coalition of six organizations:
• Gruma Corporation
• Spina Bifida Association
• March of Dimes Foundation
• American Academy of Pediatrics
• Royal DSM N.V.
• National Council of La Raza

Fortification of enriched cereal grains such as bread and pasta with folic acid was mandated by the FDA in 1998. Corn masa flour, however, lacks federal regulatory approval for the addition of folic acid. The rate of NTDs in the U.S. has decreased by nearly one-third since fortification. Despite this success, about 3,000 pregnancies in the U.S. still are affected by NTDs annually and Hispanics have the highest rate when compared to other race or ethnic groups.

Corn masa flour is made from specially treated corn and is used to make products common in Latin American diets such as corn tortillas and tamales. The petitioners believe that by targeting traditional Hispanic food made with corn masa for folic acid fortification, it would be possible to lower the rate of NTDs among Hispanics, particularly Mexican-Americans. Studies have shown that folic acid works if taken before conception and during early pregnancy. Many countries in Latin America already allow fortification of corn masa products with folic acid, including Costa Rica, El Salvador and Mexico.
 
The FDA accepted the petition on April 17. The petition now will be reviewed by the agency, which is not required to follow a prescribed timetable on the approval process. “Adding folic acid to corn masa flour can successfully decrease neural tube defects in the Hispanic community,” said Dr. Jennifer Howse, President of the March of Dimes.  “This is a safe and effective way to address the disparities we see in the Hispanic community and will give even more babies a healthy start in life. I’d like to thank our fellow petitioners for their leadership on this important health issue. We look forward to the FDA’s determination on our petition.”

We’ll keep you posted on their response.

You’ve heard a lot about the importance of folic acid. Recently, a pregnant woman wrote to us and asked exactly what she would need to eat in order to get all her folic acid needs from food instead of a vitamin. Good question…complicated answer.

The first thing you need to know is that the natural form of folic acid is called folate. Folate is found in lentils, spinach, black beans, peanuts, oranges and orange juice, legumes, romaine lettuce, leafy green veggies and broccoli. But, you have to eat a lot of these foods to get the right amount of folic acid (400 mcg per day). Cooking and storage can destroy folate, so even if you have the best intentions, your plans may be foiled. To make matters worse, according to the Institute of Medicine (IOM), your body only absorbs about 50 % of folate from food. Not much!

Fortunately, there is a way around having to eat tons of lentils and broccoli every day. The manufactured or synthetic form of folate is called folic acid. Many grain products in the United States are fortified with folic acid (meaning folic acid is added to them). The best part of this is that your body actually absorbs folic acid better than it absorbs folate. In fact, your body absorbs approximately 85% percent of the folic acid in fortified foods and 100% of the folic acid in a vitamin supplement. (I like these numbers a lot more!) That is a whole lot more than only 50% your body absorbs from foods with folate.

So where can you find these fortified foods? Enriched is the magic word. Enriched flour, rice, pasta, bread and cereals are examples of fortified grain products. You can check the label to see if a product is enriched and to see how much folic acid each serving contains.

Here’s even better news…Many studies have shown that the synthetic form of folic acid helps prevent NTDs (neural tube defects) – a kind of birth defect. This is why the IOM, the Centers for Disease Control and Prevention (CDC) and the March of Dimes recommend that all women of childbearing age consume at least 400 micrograms a day of the synthetic form of folic acid.

A simple solution…

You can eat a serving of fortified cereal that contains 100% of the daily value of folic acid every day. Or…(drumroll please…) you can pop a vitamin. Of course, a healthy diet is very important, but taking a daily multivitamin that contains at least 400 mcg of folic acid (or at least 600 mcg if you are pregnant) is key in ensuring that you are getting and absorbing the folic acid that your body needs – whether you are planning on getting pregnant or not. It really couldn’t be easier.

You may have read or heard on the news lately that a couple of recent studies are showing concerns about the health benefits of taking vitamins and supplements. While some vitamins may be questionable, folic acid is very important for all women of childbearing age. It helps to protect developing babies from certain birth defects. So keep taking it.

According to a couple of these new studies, vitamins may not be as beneficial as previously thought. The research suggests that in some instances some vitamins may be harmful as we get older. One study of older women suggests that taking vitamin supplements, including folic acid, may slightly increase a woman’s risk of death after the age of 62. Another study of men states that taking vitamin E supplements may significantly increase the risk of prostate cancer.    HOWEVER, these are single studies and much more research needs to be done before we know how accurate these results may be. 

Here is what we do know now. Research has repeatedly demonstrated that all women of childbearing age should take 400 micrograms of folic acid before getting pregnant to help prevent neural tube defects (serious birth defects of the brain and spine). This is especially important since about half of all pregnancies are unplanned. During pregnancy, women should get at least 600 micrograms of folic acid.

If you have any questions about taking vitamins, talk with your health care provider.

January 2011 is National Birth Defects Prevention Month.  This year’s theme is Medication Use Before, During, and After Pregnancy.

While most birth defects cannot be prevented because their causes are not known, women can take a number of steps before and during pregnancy to reduce their risk. These steps include taking a multivitamin containing 400 micrograms of folic acid daily starting before pregnancy and in early pregnancy. This helps to prevent serious birth defects of the brain and spinal cord, including spina bifida, and may also help prevent heart defects. Another step is getting a pre-pregnancy check up and making sure that the medications you are taking are safe to use during pregnancy.

Talk with your health care provider and pharmacist about your medications.  For the most current information about medications (prescription or over-the-counter), drugs, vaccines, chemical or environmental agents and their potential risks, we suggest that you contact a Teratology Information Service (TIS).  A teratogen is any agent or substance that can affect fetal development.  To answer questions properly, it is sometimes necessary to know how far along in her pregnancy a woman was when she came in contact with the substance, what medications she was taking at the time, some of her medical history, etc.  Trained professionals in the field of teratogens can answer your specific questions while maintaining your anonymity. They also can tell you if a medication is safe to use while breastfeeding. The national toll-free phone number to call is 866-626-6847.

Of the four million women who give birth in the US each year, some 3,000 babies are born with neural tube defects, which include certain birth defects of the brain and spinal cord. Folic acid is a critical element needed for proper spinal cord development during the first three weeks of pregnancy. Because this is often before a woman even knows she’s pregnant, it’s important for women of child-bearing age to follow a healthy lifestyle and to include folic acid as part of their diet.

The Grain Foods Foundation has joined with the March of Dimes to remind all women of child-bearing age of the important role folic acid plays in preventing birth defects. Enriched breads – and many other grains such as rice, tortillas, pasta and cereal – are important sources of folic acid. 

• White flour is enriched with three major B vitamins (niacin, thiamin and riboflavin), as well as iron, and is fortified with the B vitamin folic acid.
• Enriched flour contains two times as much folic acid as its whole grain counterpart – making enriched grains the largest source of folic acid in the diets of most Americans. Whole grain products, with the exception of some breakfast cereals, are not fortified with folic acid.
• Since the FDA required fortification of enriched grains, the number of babies born in the U.S. with neural-tube birth defects has declined by 34 percent in non-Hispanic whites, and by 36 percent among Hispanics.

Grain foods are a delicious and nutrient-dense component of a healthy diet and have been shown to help with weight maintenance. In fact, people who consume a medium-to-high percentage of carbohydrates in their diet have a reduced risk for obesity. This is important for women of childbearing age as obese women who are pregnant have a significantly higher risk of needing a Cesarean section delivery, delivering too early, developing pre-eclampsia, and having an exceptionally large baby. They also face double the risk of stillbirth and neonatal death.

For a balanced diet, the USDA recommends at least six one-ounce servings of grains daily. Any food made from wheat, rice, oats, cornmeal, barley or another cereal grain is a grain product. Bread, pasta, oatmeal and even tortillas and pretzels are examples of grain foods.

During the holidays, cooking up something in your kitchen (and then eating it) creates lasting memories. Many years ago I made these cookies with my Mom, and now they are a holiday staple in our house. I don’t remember where the recipe came from – it was probably on the Kelloggs box, or perhaps it was on the Toll House chocolate chips package.  Wherever they came from, they are definitely worth passing on.

It is especially memorable to make goodies with young children, but it is often hard to find a recipe that caters to a short attention span. The following recipe is great for a number of reasons – it is something young kids can make with you, it doesn’t require a lot of ingredients or even an oven, and it is reasonably healthy.  In fact, as cookies go, it contains peanut butter (protein), chocolate (anti-oxidants if you use dark chocolate) and corn flakes (which are fortified with folic acid)!  So, it is practically a guilt-free indulgence! Keep in mind that many people have soy or peanut allergies, so let your guests know that it contains peanuts and that the corn flakes may contain trace amounts of soy. 

So go ahead and enjoy…and remember that moderation is the key.

Corn Flake Cookies

6 Tbsp peanut butter
One 12 oz. package of chocolate chips* (I suggest Toll House Nestle Real Semi-Sweet chocolate chips)
6 cups corn flakes
Wax or parchment paper

In a large bowl, melt peanut butter and chocolate in the microwave. I suggest microwaving in 30 second increments, until chips are melted. Microwave ovens vary, so be careful not to overheat the mixture….only heat until melted.
Stir until well blended.
Add corn flakes and mix thoroughly until all corn flakes are coated with the chocolate mixture.
Cover a flat plate or cookie sheet with wax or parchment paper.
Drop heaping teaspoonfuls of cornflakes onto wax paper to make individual cookies. If you prefer, you can drop the cookies into cupcake paper liners instead.
Chill in refrigerator until cold and solid (about 30 minutes or less).
Remove from wax paper and serve.

You can store the cookies in a cookie tin for 1-2 weeks.

*Milk chocolate or dark chocolate chips may be used – it depends on your taste. If you use dark chocolate, you will get the benefits of antioxidants, but it won’t be as sweet.

Enjoy… and let’s hear your review!