9 ways to reduce the risk of congenital differences

Every year, about one of every 33 newborns in the United States (nearly 120,000 overall) will have a congenital difference, a health condition that is present at birth. These include things that are visible (such as a cleft palate or extra fingers or toes), and those that are not immediately apparent (such as hearing loss or heart complications). These differences usually have a genetic basis, but some are caused by exposure to certain medications, infections, and chemicals during pregnancy. Still others are related to a combination of factors or are caused by unknown factors.

Congenital differences are common and they are also the leading cause of death in infants in the U.S. While not all of these conditions are fatal, some can cause lifelong health issues.

Not all congenital differences can be prevented, but there are some things you can do before and during pregnancy to lower the risk, says Tracy Nelson, MD, an OBGYN affiliated with Grand Strand Medical Center in Myrtle Beach, South Carolina.

Here’s a look at some of the most common congenital differences, plus essential health tips for expectant parents.

Congenital differences can impact various parts of the body. “There are major and minor birth differences,” says Dr. Nelson. Major ones include anything that may require additional treatment or have social implications.

Some birth differences are related to structural development, such as:

• Cleft lip or palate
• Heart complications: missing or misshaped valves, chambers, arteries, or veins
• Limb differences: clubfoot, additional fingers and toes, or underdeveloped limbs
• Neural tube issues: differences in the growth and development of the brain and spinal cord, including spina bifida and anencephaly (missing parts of the brain and skull)

Birth issues that impact how certain parts of the body work are known as functional or developmental concerns, such as:

• Nervous system or brain differences that affect intellectual, developmental, and behavioral functioning, including Down syndrome, Prader-Willi syndrome, and Fragile X syndrome
• Sensory differences: hearing loss, blindness, or deafness
• Metabolic conditions: hypothyroidism or phenylketonuria (a rare condition in which an amino acid called phenylalanine builds up in the body)

Anyone who is planning to get pregnant should see their gynecologist every year—even if they don’t need a Pap smear—to discuss changes in family history, receive a pelvic exam (in some cases), and complete any recommended genetic testing. You can also discuss fertility plans, sexual concerns, and vaccinations. If you’re planning to start a family, certain blood tests may be able to detect possible genetic issues that could lead to congenital differences down the road.

Once you are pregnant, call your healthcare provider (HCP) right away so you can start prenatal care. This can help your HCP catch any potential issues, like infections or conditions that could cause complications for you or your growing fetus. Routine blood work can detect whether you’re protected from rubella (German measles) or if you have infections like chlamydia, syphilis, gonorrhea, or human immunodeficiency virus (HIV), all of which could have an impact on your pregnancy. Regular ultrasounds will also be a part of your prenatal care plan. These tests can help your HCP spot any developmental concerns and monitor how the fetus is growing.

After your initial OBGYN appointment, your HCP will discuss how often you’ll need to come in for ultrasounds and other testing, or if any specialist visits may be necessary. It’s important to stick to all appointments so your HCP can monitor your health and how the fetus is progressing.

The first thing Nelson advises pregnant people to do is to take a daily folic acid supplement. Folic acid, a form of the B vitamin folate, is essential for preventing brain and spinal birth issues such as anencephaly and spina bifida. If you’re planning to become pregnant, follow the recommendations of your HCP about what type of prenatal vitamin to take and how much folic acid supplementation you should be getting. The typical amount is between 400 to 800 micrograms of folic acid per day—don’t take more than that unless your HCP prescribes a larger amount. As soon as you are pregnant, talk to your HCP about switching to a daily prenatal vitamin that contains folic acid as well as other important nutrients.

Certain foods such as fortified cereal and pasta, leafy greens, and citrus may also contain large amounts of folic acid or folate, so you may want to increase your intake of those nutrient-rich foods, too, in consultation with our HCP.

Ask your OBGYN for recommendations and samples of different brands and types of prenatal vitamins and how to choose the one that’s right for you. Some pregnant people may need more folic acid than others. “If you have a family member or a previous child with neural tube differences, or if you have a condition like celiac disease or inflammatory bowel disease, you may need to take more,” says Nelson.

No amount of alcohol during pregnancy is considered safe, so it’s best to avoid it completely. It’s also advisable to avoid alcohol if you’re planning to get pregnant. Any alcohol you consume when you’re pregnant can pass to your fetus through the umbilical cord and increase the risk of miscarriage, stillbirth, and a constellation of physical, behavioral, and intellectual disabilities known as fetal alcohol spectrum disorders (FASDs).

Those with FASDs may experience a variety of issues as infants and throughout their lives, including:

• Differences in facial features
• Small head size
• Shorter-than-average height
• Low body weight
• Coordination issues
• Overactive behavior
• Intellectual differences
• Vision or hearing issues
• Problems with the heart, kidneys, or bones

If you’re concerned about your alcohol use or have alcohol dependence, talk to your HCP or reach out to the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 800-662-4357 for free, confidential, 24/7 information and resources that can help you quit.

Your own health is at risk any time you smoke but smoking during pregnancy can also harm your developing fetus. Heart and kidney complications as well as cleft lip, cleft palate, gastroschisis (an intestinal issue), and incomplete closure of the abdominal wall have all been associated with smoking while pregnant, says Nelson. Smoking during pregnancy can also increase the risk of preterm birth and sudden infant death syndrome.

The best thing to do is to quit smoking before you are pregnant or try to quit as soon as you find out you’re pregnant. If you don’t smoke, steer clear of anyone who does, since secondhand smoke can cause harm, too. Remember that it’s never too late to quit, even if you’re pregnant.

If you’re looking to quit or you’re not sure how to start, talk with your HCP or call 1-800-QUIT-NOW for free coaching, a quit plan, educational materials, and a list of local smoking cessation resources in your area.

As much as possible, it’s also important to avoid other substances in your environment tat may be harmful to a developing fetus. For example, if you work with pesticides, lead, or radiation or chemotherapy drugs, let your HCP know and speak with your supervisor about making changes on the job to reduce your exposure to these chemicals.

You should also reduce the amount of mercury you take in through your diet, as it can also affect a developing fetus. Certain types of fish that are particularly high in mercury include swordfish, king mackerel, and tilefish.

Marijuana, cocaine, opioids, and other drugs can cross the placenta and pass through to the developing fetus, causing harm.

In addition to miscarriage, growth issues, premature birth, and stillbirth, cocaine is associated with birth differences of the brain and spinal cord, urinary tract, and bones. The impact of marijuana on a growing fetus is still unclear, but amphetamines—like speed, or crystal meth—have been connected to certain heart complications and poor growth.

Talk with your HCP or contact the SAMHSA National Helpline at 800-662-4357 if you need help quitting drugs. If you take drugs and are planning to get pregnant, try to stop using drugs well before you do get pregnant.

When you’re pregnant, you’re at higher risk for certain infections, due to lower immunity that happens during pregnancy. Some of these infections can cause serious illness and congenital issues such as microcephaly or hearing loss and other differences that can last a lifetime. There are many steps you can take to lower your risk of contracting infections:

• Avoid traveling to areas with high risk of viruses such as Zika when you’re pregnant.
• Avoid soft, unpasteurized cheeses and deli meats to lower your chances of contracting listeria, an infection that’s usually caused by consumption of contaminated food and is accompanied by fever and other flu-like symptoms.
• Steer clear of cat litter to protect yourself from toxoplasmosis, a serious disease caused by a parasite that can lead to fetal organ damage. If you have to clean your cat’s box, use gloves and wash your hands thoroughly afterwards.
• Avoid contact with rodents such as mice, hamsters, or guinea pigs. These animals could carry the lymphocytic choriomeningitis virus, which in serious cases could lead to meningitis, encephalitis, or inflammation of the brain.
• Keep an eye on food recalls and don’t take chances with food that’s been sitting in the fridge or on the kitchen counter too long.

Always practice good hygiene while pregnant. Wash your hands often, especially after using the bathroom, touching raw meats or veggies, handling pets, or playing with children.

If you contract an infection such as rubella during pregnancy, it can potentially lead to poor fetal growth, heart complications, hearing loss, or developmental issues. Chickenpox may also increase the risk of miscarriage, eye damage, limb differences, blindness, or intellectual differences, so it’s important to make sure you are up to date on the recommended vaccinations.

While we are still learning about the effects of COVID on pregnancy, the Centers for Disease Control and Prevention (CDC) reports that people who are pregnant are more likely to develop severe illness from COVID than those who are not pregnant, and they also may be at greater risk of preterm delivery or stillbirth. So be sure you have had the most updated COVID vaccines and boosters.

Getting the COVID vaccination when pregnant is linked to a lower risk of infant hospitalization, according to the CDC. And the shot appears to be safe for pregnant people: The CDC notes that vaccination during pregnancy has not been linked to an increased risk of adverse outcomes for the pregnant person or baby.

Prior to becoming pregnant, discuss your vaccination history with your OBGYN so you can get any necessary shots that are unsafe to administer during pregnancy, like the MMR (measles-mumps-rubella) vaccine. Once you are pregnant, it’s important to stay up to date with any vaccines like the Tdap vaccine (to protect against adult tetanus, diphtheria, and acellular pertussis) as well as shots for the flu, hepatitis B, or others you may need if you travel overseas while pregnant.

If you have any chronic health conditions, such as high blood pressure or diabetes, it’s important to get them under control before you become pregnant.

“Pregnancy is a stressor, so for those with diabetes, we can get you on a really effective insulin regimen before pregnancy,” says Nelson. “But once you’re pregnant, we’re chasing our tail to try to control your blood sugar with a growing pregnancy.” If blood glucose levels are too high, there’s an increased risk of heart, brain, and spine complications in the fetus as well as a greater risk of miscarriage, premature delivery, and large birth weight.

Uncontrolled chronic high blood pressure prior to pregnancy can slow fetal growth, increase the risk of preterm delivery, placental abruption, low birth weight, and preeclampsia. Obesity and autoimmune disorders may also increase the risk of congenital issues.

Regardless of your condition, make sure you’ve consulted with the appropriate HCPs prior to pregnancy about developing a management plan. When you become pregnant, see your HCP right away to discuss treatment options that are safe for both you and your developing fetus.

It’s always a good idea to keep your HCPs in the loop when it comes to the medications and supplements you’re taking, but you’ll want to be especially forthcoming during pregnancy. What you put in your body during the first 12 weeks of your pregnancy is particularly important, since your fetus’s vital organs are developing during that time. Many medications have not been tested for safety during pregnancy and others have known side effects that can damage the heart or brain.

Make a list of every over-the-counter or prescription medication, vitamin, dietary supplement, and herbal product you’re taking and discuss with your OBGYN as soon as you know you’re pregnant. If you’re trying to become pregnant, it’s a good idea to discuss your list at a routine OBGYN visit. Your HCP may suggest alternative treatments or lower doses or may advise you to stop taking the medication altogether. You should never start or stop taking any medication without first discussing it with your HCP, whether you’re pregnant or not.