By Lori Wolfe, CGC, MotherToBaby North Texas

January is Birth Defects Prevention Month, and it’s a great time to remind ourselves that there are 5 things that pregnant women can do to reduce their chance of having a baby with a birth defect. The 5 tips include:

  1. Be sure to take 400 micrograms (mcg) of folic acid every day.
  2. Book a visit with your healthcare provider before stopping or starting any medicine.
  3. Become up to date with all vaccines, including the flu shot.
  4. Before you get pregnant, try to reach a healthy weight.
  5. Boost your health by avoiding harmful substances during pregnancy, such as alcohol, tobacco, and other drugs.

Reviewing this list of tips reminded me of a call I answered last month as a Teratogen Information Specialist at MotherToBaby North Texas. The woman calling, Beatriz, was upset and concerned. She had just found out that she was about five weeks pregnant. As she suffers from chronic migraine headaches, Beatriz was taking Valproic Acid, a medication that has been shown to be effective in preventing migraines. Beatriz had done a little research on her own and knew that there could be an increased risk for birth defects in women taking this medication while pregnant. She went on to explain that she had been planning to become pregnant, and was trying to do everything right, including reaching a healthy body weight, getting her flu shot a couple of months ago, and taking her daily vitamin with folic acid. But… as often happens, Beatriz got pregnant earlier than she had planned. Hence her panic and many questions!

I explained to Beatriz that I often talk with women in these types of situations. So I started by reminding Beatriz that with every pregnancy there is a small 3-5% background chance for having a baby with a birth defect. As Beatriz had learned from her own research, taking Valproic Acid in the first part of a pregnancy increases the risk for spina bifida by 1-2% (spina bifida is a birth defect that occurs when a baby’s spine and spinal cord don’t form properly; see our fact sheet at https://mothertobaby.org/fact-sheets/valproic-acid-pregnancy/). Upon hearing this confirming information, Beatriz immediately stated that she would stop taking her medication to take away this possible increased risk. I responded that it is always best to talk with your healthcare provider before stopping or starting any medications during pregnancy (see tip #2). They know you and your pregnancy best, and can give you personalized advice, not just general information. I told Beatriz that before making any changes to her medication, she really needs to discuss with her healthcare provider the benefits of taking the medication versus the risk to staying on the medication.

Beatriz mentioned she has been taking a daily prenatal vitamin with folic acid as she knew that she was planning to get pregnant (tip #1). Folic acid is the lab-made form of the vitamin folate (vitamin B9). Folate is necessary for making and maintaining healthy cells in your body. Taking recommended amounts of folic acid has been shown to reduce the percentage of babies born with birth defects, including spina bifida (see our fact sheet at https://mothertobaby.org/fact-sheets/folic-acid/.) Starting at least one month before pregnancy, the recommended daily amount of folic acid is 400 micrograms (mcg), or 0.4 milligrams (mg). During pregnancy, the recommended daily amount is 600-800 mcg. Many daily and prenatal vitamins already contain the required amount of folic acid. Beatriz checked the vitamin she had been taking and saw that it did contain 800 mcg of folic acid.

While planning to become pregnant, Beatriz has also mentioned that she been eating a better diet and had started an exercise program. She was happy to report to me that she has lost 25 pounds over the past six months and is now at a healthy body weight (tip #4). Now that Beatriz knows she is pregnant, she can continue an exercise program that is appropriate for pregnancy. I told Beatriz she might want to chat with her healthcare provider and ask any questions she may have about appropriate exercise during pregnancy, such as walking and swimming. (See our fact sheet at https://mothertobaby.org/fact-sheets/exercise-pregnancy/.)

I asked Beatriz about vaccinations, and she said she is up-to-date on all her vaccines, including having received her flu vaccine earlier this fall (tip #3). It is recommended that women who are pregnant (whether in their first, second, or third trimester) or planning to become pregnant get the seasonal flu shot given by injection. The flu shot is a dead, inactive vaccine and there is not a known increased risk for birth defects or other pregnancy problems. (See our fact sheet at https://mothertobaby.org/fact-sheets/seasonal-influenza-vaccine-flu-shot-pregnancy/.) Beatriz also mentioned that she plans to talk with her healthcare provider about getting the pertussis vaccine (know as TDaP), as this vaccine can help protect her baby from whooping cough, a potentially serious illness for babies. (See our fact sheet at https://mothertobaby.org/fact-sheets/tetanus-diphtheria-pertussis-tdap-vaccine-pregnancy/.)

Beatriz also reported to me that she had already stopped drinking alcohol as she knew there is not a known safe level of alcohol use when pregnant, and she also did not use any tobacco or other drugs (tip #5). These are critical steps in preparing for a healthy pregnancy, as outlined in another one of our blogs: https://mothertobaby.org/baby-blog/alcohol-smoking-and-other-drugs-why-ten-fingers-plus-ten-toes-doesnt-always-equal-the-whole-story/.

After reviewing all of this information with Beatriz, she stated that she would call her healthcare provider in the morning to discuss whether she should stop taking Valporic Acid and determine if there any alternative treatments for her migraines that might be safer in pregnancy. Beatriz was happy to hear that she was well prepared for her pregnancy, having already successfully completed 4 of the 5 recommended tips. Even though Beatriz became pregnant a few months earlier than she had wanted to, she was now excited and thrilled to be pregnant.

So what’s the takeaway from Beatriz’s story? There are things you can do to prepare yourself for a healthy pregnancy and to decrease the chance of having a baby with a birth defect. So if you are pregnant or planning to become pregnant, do yourself and your baby a favor and review the 5 tips. And as always, if you have any questions about an exposure during pregnancy – such as a medication, supplement, vaccine, or recreational substance – our MotherToBaby specialists are here to help!

Lori Wolfe, CGC, is a board certified Genetic Counselor and the Director of MotherToBaby’s North Texas affiliate. MotherToBaby aims to educate women about medications and more during pregnancy and breastfeeding. Along with answering women’s and health professionals’ questions regarding exposures during pregnancy/breastfeeding via MotherToBaby’s toll-free number, text line and by email, Wolfe also teaches at the University of North Texas, provides educational talks regarding pregnancy health in community clinics and high schools.

About MotherToBaby

MotherToBabyis a service of the Organization of Teratology Information Specialists (OTIS), suggested resources by many agencies including the Centers for Disease Control and Prevention (CDC). If you have questions about exposures during pregnancy and breastfeeding, please call MotherToBaby toll-FREE at 866-626-6847 or try out MotherToBaby’s new text information service by texting questions to (855) 999-3525. You can also visit MotherToBaby.org to browse a library of fact sheets about dozens of viruses, medications, vaccines, alcohol, diseases, or other exposures during pregnancy and breastfeeding or connect with all of our resources by downloading the new MotherToBaby free app, available on Android and iOS markets.