1. Prevention of Birth Defects An Overview of Primary and Secondary Strategies

2. Primary Prevention Single Gene Disorders No medical intervention available to correct underlying pathology. Prevention is dependent upon pre- conceptual genetic counseling of at-risk couples.

3. Primary Prevention Teratogenic Disorders Teratogen- any environmental influence that adversely affects the normal development of the fetus A wide variety measures are available to protect the otherwise healthy fetus from in utero damage. These include education concerning of the mother concerning nutrition and exposure to teratogenic agents and also Screening for infectious diseases.

4. Primary Prevention Chromosomal Disorders These disorders are not systematically predictable and risk factors are not determined. Aside from pre-conceptual counseling in cases where known risk factors are present primary prevention strategies are not available.

5. Primary Prevention Mulifactorial disorders Neural tube defects including spina bifida were linked to maternal folic acid deficiencies in the early 1990’s. In 1996 folate supplementation was recommended for women anticipating conception or in the first trimester of pregnancy. In 1998 folate supplementation was required in grain products produced in the U.S.

7. Secondary Prevention of Birth Defects Prenatal Diagnosis

8. The diagnosis of a disease or a condition in a fetus or embryo before it is born. The decision as to whether to use prenatal diagnostic procedures is one made as a result of consultation between the family and the care provider. There is no absolute requirement for the utilization of these technologies in any circumstance.

9. Prenatal Diagnosis Candidate pregnancies for screening: + advanced maternal age >35 + previous offspring that were premature or had abnormalities + chromosomal abnormalities in either parent + parents at risk for in-born errors of metabolism + high levels of maternal serum alpha fetoprotein (AFT)

10. Prenatal Diagnosis Techniques Ultrasound Routinely done around 20 weeks Detects structural defects Determines gestational age and sex No Risk

11. Prenatal Diagnosis Transabdominal Amniocentesis ~ 1/4 cup of amniotic fluid removed at 16 wks. Fluid is produced by fetal lungs, kidneys and umbilical cord. The fluid contains shed fetal skin cells and biochemical substances produced by the fetus. AFT may indicate neural tube defects Complication rate: <5%, Miscarriage:.25-.50%

12. 1 2

13. Prenatal Diagnosis Chorionic Villi Sampling Performed at 8-10 wks Involves passing a small catheter through the vagina into the uterus Small samples of cells are taken from the placenta, where it attaches to the wall of the uterus. Miscarriage rate is.5 -1.0%

14. 1