Preventing Birth Defects : Nursery, Accutane and Birth Defects

by Food and Drug Administration (FDA)

(Page 3 of 3)

Who Should Paint the Nursery?

Chemicals — whether it's paint in the nursery or exhaust fumes in a parking garage — have long been suspected of causing birth defects. It's important for pregnant women to realize that most birth defects are not caused by a single factor, nor are they usually caused by faint traces of toxins. Scientists believe it takes a combination of factors to trigger a congenital malformation.

"Most birth defects have one or more genetic factors and one or more environmental factors," explains Richard Leavitt, director of science information at the March of Dimes.

Most of the chemicals a pregnant woman encounters pose little threat compared with the harm in smoking, drinking alcohol, or eating a poor diet.

"Most environmental exposure is at a low level compared to things you put in your mouth or inhale purposefully into your lungs," Leavitt says. "Public health warnings are aimed at the many to help the relatively few avoid a problem."

Daily, heavy exposure to chemicals may be dangerous, however. If a pregnant woman must work around fumes or chemicals, such as in a dry-cleaning business, art studio, or factory, she should use gloves, masks and adequate ventilation. But if she just gets a whiff of dry-cleaning fluid while picking up her laundry from the cleaners, there's little need to worry, Leavitt says.

Some environmental toxins such as lead are best avoided at any time, but especially during pregnancy. Scraping leaded paint off an old house window, drinking water from a pipe soldered with lead, or drinking out of decorative pottery containing lead can all potentially cause lead poisoning — and mental retardation — in a fetus. (See "Dangers of Lead Still Linger" in the January-February 1998 FDA Consumer.)

Radiation is also dangerous to developing babies. A pregnant woman who works in an x-ray department of a hospital must take precautions to avoid exposure. Elective dental x-rays should be postponed until delivery, and any nonpregnant woman who has an x-ray should have her reproductive organs shielded with a lead apron.

Taking hot baths, using saunas, or exercising in hot, humid weather can raise a woman's core temperature and have the potential to cause birth defects, especially in the first trimester. Lukewarm baths and moderate exercise are fine, however.

And what about computers or video display terminals? Although they have at times been accused of causing harm, there's probably no need to worry. Recent studies have not found any relationship between computer terminals and miscarriages.

And as for who should paint the nursery — today's paints don't contain lead and therefore probably aren't dangerous. But there are other reasons to find someone else to do this task. The repetitive motion of painting can be a strain on back muscles already under pressure from the extra weight of pregnancy, and standing on your feet for hours can make advanced pregnancy miserable. If someone else can do it, pass this chore along.

Of all the environmental harms, undoubtedly the most harmful is one women can control — smoking. Although there is no evidence smoking causes birth defects, it deprives the fetus of oxygen and leads to a number of problems. If all pregnant women avoided smoking, the United States would see a 5 percent reduction in miscarriages, a 20 percent reduction in low-birth-weight births, and an 8 percent reduction in premature deliveries in this country, according to the March of Dimes.

In the Family

Finally, a number of birth defects are inherited. They are usually triggered when the child inherits a matching pair of disease-causing genes, one from each parent. This is most often an issue for couples of similar ethnic or geographic origins.

For example, African-American couples are most at risk for having a child with sickle cell anemia. According to the March of Dimes, couples of Ashkenazic Jewish or French Canadian descent may be carriers of Tay-Sachs disease. People who know of genetic disorders in their families, or those who have already had one child with a disorder are also at a greater risk, as are couples who are closely related, such as first cousins. Genetic testing is available to determine the risk of passing some genetic disorders to an unborn child. Once a pregnancy begins, prenatal testing is available to detect a number of disorders, as well.

Some genetic abnormalities, such as Down syndrome (a genetic abnormality that causes mental retardation, short stature, and flattened features), increase with the parents' ages. Women over 35 are at higher risk of having a child with Down syndrome — about 1 in 100 for a 40-year-old, compared to 1 in 10,000 for a 20-year-old mother or 3 in 1,000 for a 35-year-old mother. And it's not always just the mother's age that matters. An estimated 25 percent of Down syndrome cases can be attributed to increased age of the father.

Finally, it's important to remember that for most healthy women, the incidence of birth defects is very low — less than 3 percent. And of malformations that do occur, the most common are also the most treatable. Cleft palate and club foot, two of the more common birth defects, can be surgically repaired. Many heart malformations can be repaired with surgery so that children live normal lives.

For the most part, health experts say, a woman can do a lot to ensure the health of her child by maintaining a healthy lifestyle.

Accutane and Birth Defects

Accutane (isotretinoin), a relative of vitamin A, is approved to treat severe cystic acne that doesn't respond to other drugs. It has some serious side effects, though, especially if a woman taking it becomes pregnant.

The drug's manufacturer has included strong warnings in the package labeling to inform doctors and patients about the birth defects this drug can cause.

Pregnant women who take Accutane even for a short time are at great risk of having a baby with severe facial birth defects, malformed thymus glands, and mental retardation.

The risk is so great that any woman of childbearing age who is taking Accutane — even if she's not sexually active — must also use effective contraception at least one month before beginning Accutane, while using the drug, and for one month after stopping.

About the Author

www.fda.gov
FDA is A United States government body that oversees medical devices, including contact lenses, intraocular lenses, excimer lasers and eyedrops. In the US, these products must be approved by the FDA before they can be marketed.