Op-Ed on Perinatal Health

The greatest joy of parenting is to bring home a healthy infant after a 40-week gestation period. This is never the case for everyone, as the Centers for Disease Control and Prevention subtly affirm when marking January as the National Birth Defects and March 3, the World Birth Defects Day. Worldwide 3-6% of births record severe defects. This translates into 8 million babies with irreversible conditions, and in case they survive, most live with lifelong disabilities. The Centers for Disease Control and Prevention and its partners, including Operations Smiles dedicate resources to fight stigma and create awareness about birth defects.

An understanding of birth defects is critical to determining preventing measures. In 2016, the Centers for Disease Control and Prevention recognized the link between the Zika virus and outbreak birth defects in Colombia and Brazil. Institutional researchers expressed interest in birth defects among women infected by the Zika virus during the period. Such developmental challenges also emerged in Botswana where the Centers for Disease Control and Prevention studied women on Antiretroviral Therapy for the human immunodeficiency virus. The research drew public interest into an ethical dilemma in medical practice. It became challenging to strike a balance between saving mother or child. The consequence of the therapy was spine and brain deformities. HIV treatment is one thing and an expectant woman on prescription medication adds a layer of vulnerability to an unborn child. According to a study conducted by the Better Health Channel, it became apparent that teratogenic medications increase the risk for birth defects. Some of the medications are painkillers or prescribed substances for cancer management, thyroid disease, or blood conditions. In such a context, a woman’s wellbeing depends on the prescription medication, which places an innocent life on a delicate balance.

Drugs are categorized into several classes, but the most important one to assess class ‘x’ medications, which patients must not use since they present a significant risk for birth defects. A fascinating, yet disturbing finding is that at least 8% of women globally rely on medication for an underlying health problem (Centers for Disease Control and Prevention, 2023). Common conditions warranting medication include diabetes, pre-eclampsia, blood pressure, anemia, asthma, epilepsy, pneumonia, and thyroid disease. Such life-threatening conditions predispose mother and child to danger, forcing pregnant women to rely on teratogenic medications. In Hungary where 92% of the female population relies on medications and supplements during pregnancy, birth defect rates are very high, as Bánhidy et al. (2005) denote. The drugs are not the only causes of birth defects and miscarriages or stillbirths since women in such conditions should not experience rubella infections. Sources confirm that over 77% of the world’s children population has received rubella immunization. As a result, most women enjoy lifelong protection, but in case of an attack in pregnancy, additional protection becomes necessary, which means innocent children are exposed to birth defects at in utero.

Congenital rubella and teratogenic drugs are only part of a collection of factors such as risky lifestyles such as alcoholism, smoking, and substance abuse that cause conditions such as the fetal alcohol syndrome in fetus. While most people can overcome risks, it is almost impossible to stop taking medications for life-threating conditions while pregnant. Bánhidy et al. (2005) call for extensive research in the area of teratogenic drugs to eliminate risks in the first trimester. Dr. Ahmed Baschat reviewed an article by the John Hopkins hospital concerning teratogenic substances and insisted on the value of prenatal care medications such as 400 micrograms of folic acid daily to eliminate the risk of birth defects. The doctor also emphasized the significance of remaining aware of one’s medical status before conceiving. In utero, one can prevent birth defects by addressing congenital diaphragmatic hernia through fetoscopic endotracheal occlusion. It involves a surgical activity to seal a hole in the diaphragm that allows liquid to enter the lungs of a developing fetus. Alternatively, lower urinary tract obstruction might block the urinary tract, but surgery in the initial stages of development can relieve the blockage. A laser surgery can also prevent a twin-twin transfusion syndrome to address the imbalance in blood volume.

            Although these solutions are glorified, not every parent can afford ultrasound screening to determine if a fetus has Downs Syndrome. In addition, the complex knowledge is easy to translate to literate audiences who can understand terms such as maternal screening for human chorionic gonadotropin protein presence. Other technical, yet necessary exercises include fetal echocardiogram, maternal serum screen, anomaly ultrasound, Chorionic Villus Sampling, and Amniocentesis. To be frank, most of the services meet the healthcare needs of a small societal proportion. Millions of women globally continue to suffer due to financial constraints and lack of knowledge. The best a government can do is to provide such services under a national healthcare insurance program that offers equal opportunities for everyone. Moreover, governments must work with Non-Governmental institutions and research facilities to increase awareness about birth effects as they find additional solutions to the health problem. Everyone deserves an equal chance at survival irrespective of demographic disparities. If governments can facilitate citizens with such services, pregnant women will go through the surreal journey without anxiety.

References

Bánhidy, F., Lowry, R.B., & Czeizel, A.E. (2005). Risk and benefit of drug use during pregnancy. Int J Med Sci, 2(3):100-106. doi:10.7150/ijms.2.100. https://www.medsci.org/v02p0100.htm

Better Health Channel. (n.d). Drugs, medication and birth defects. https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/drugs-medication-and-birth-defects

Centers for Disease Control and Prevention. (2023 February, 27). World Birth Defects Day 2023: Global Efforts to Raise Awareness and Support Families. https://www.cdc.gov/globalhealth/stories/2022/world-birth-defects-day-2022.html#:~:text=Every%20year%2C%20about%203%25%E2%80%93,birthplace%2C%20race%2C%20or%20ethnicity.

John Hopkins. (n.d). Preventing and treating birth defects: What you need to know. https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/preventing-and-treating-birth-defects-what-you-need-to-know