About 3 to 5 percent of all babies are born with birth defects. Statistics indicate that birth defects account for the largest percentage of all infant deaths in North America. Many birth defects are not preventable, because the cause of them is unknown.

Researchers do know, however, that most birth defects occur in the first three months of pregnancy, often before a woman even knows she is pregnant. It is becoming increasingly evident that your state of health at the time of conception is one of the most important factors in protecting your baby from preventable malformations.

Neural Tube Defects

Neural tube defects are congenital malformations that occur during fetal life. They are caused by failure of the neural tube—that eventually forms the body’s central nervous system—to close. Neural tube defects are one of the most common congenital malformations seen among live-born infants in North America. The most common neural tube defects are spina bifida and anencephaly.

It’s been estimated that approximately 2500 U.S. babies a year are born with neural tube defects, half of whom will have spina bifida, a neural tube defect that prevents the vertebrae of your baby’s spine from closing completely. In severe cases, the spinal cord protrudes outside of your baby’s body, limiting mobility and causing other neurological dysfunctions. Spina bifida can be surgically corrected, but surgical repair of the lesion is not always associated with improvement in motor function. Children with spina bifida often have long-term problems that require management by a healthcare team.


One nutrient known to prevent birth defects is folate. Folic acid is the synthetic form of folate, the B vitamin necessary for cell division. Making sure you are getting plenty of folate in your diet and taking a folic acid supplement will reduce your chance of having a child with abnormalities of the spine and brain, such as spina bifida.

Folate is needed both before and during the first few weeks of pregnancy to help prevent birth defects. Neural tube defects can occur in a fetus before a woman even realizes she’s pregnant. That’s why it is so important for all women of childbearing age to pay attention to their folate intake. When you become pregnant, your folate requirements increase from 400 micrograms per day to 600 micrograms.

See the Folate in Foods table on page 7 in chapter 1 for food sources of folate. Getting your daily 600 micrograms of folic acid from foods is a challenge, even for the healthiest of eaters (unless you’re a fan of chicken liver!). It’s also known that the synthetic folic acid used in supplements and fortified foods is better absorbed by the body than the B vitamin in foods. For these reasons you are strongly advised to take a folic acid supplement before and during your pregnancy. I recommend that you

start taking a prenatal vitamin supplement that offers 400 to 1000 micrograms of folic acid while you are trying to get pregnant and during your pregnancy—most prenatal formulas offer 1000 micrograms of folic acid.

If you take a separate folic acid supplement, be sure to buy one that has vitamin B12 added. High doses of folic acid taken over a period of time can hide a B12 deficiency and result in progressive nerve damage. The upper limit for folic acid intake from a supplement is 1000 micrograms (1 milligram) per day.

Other Causes of Birth Defects

One vitamin you don’t want to get too much of during your pregnancy is vitamin A. In fact, if you take a vitamin supplement, make sure it contains no more than 5000 international units (IU) of vitamin A. Most prenatal formulas provide 2500 IU of the vitamin. High intakes of supplemental vitamin A (more than 10,000 IU) are associated with birth defects. You may have read that the nutrient beta-carotene is converted to vitamin A in the body. This is true, but it is not transformed to vitamin A efficiently enough to cause toxicity; don’t worry about your beta-carotene intake.

Infectious diseases, such as rubella (German measles) and syphilis can also cause birth defects. Syphilis should be treated with an antibiotic before you become pregnant because it can cause bone and tooth deformities. If you have not had rubella, you should be vaccinated against the disease before you become pregnant. Because the vaccine can also pose problems for a developing fetus, you should wait three months after vaccination before becoming pregnant. A rubella infection in early pregnancy will cause abnormalities in the heart, eyes and ears of your fetus.


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