Local Clinic Works To Prevent Birth Defects

Having a healthy baby takes a bit of work and awareness... Birth defects, if they are severe, can affect not only the baby but the whole family for the rest of their lives. And the costs... can be enormous.. The cost of lifetime care for all infants born in a single year with one or more severe birth defects has been estimated at $6 billion.

SO it's worth learning how to avoid them !

Guest: Dr. Jacqueline Guererro, OB-GYN, San Ysidro Health Center

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ALISON ST. JOHN: You're listening to These Days on KPBS here on KPBS. I'm Alison St. John sitting in for Maureen Cavanaugh. Having a healthy baby takes a bit of work and awareness. Birth defects if they're severe can affect not only the baby but the whole family for the rest of their lives, and the costs can be enormous. The cost of lifetime care for all infants born in the United States with -- in one year with one or more severe birth defects has been estimated at $6 billion. So it's worth learning how to avoid them. January is national birth defects awareness month, and we've brought in an OBGYN to help us understand what's at stake here, and what we can do. So doctor Jacqueline Guerrero from the San Ysidro Health Center is with us. Doctor Guerrero, thanks so much for joining us.

GUERRERO: Good morning, thank you.

ALISON ST. JOHN: So tell us, first of all, what are some of the common birth defects that you see in your practice?

GUERRERO: So, there are a large amount of birth defects that we do see across the spectrum of disorders. The most common ones that we do see across the country and in San Diego are things like neural tube defects, which is essentially the failure of the neural tube to close during the beginning of a pregnancy, and this affects the central nervous system, brain and spinal cord development and can lead to long-term deficits in the fetus as it grows. And we also see Trisomy 21, which essentially is down syndrome, in layman's terms, and that's a chromosomal defect that happens during the beginning of pregnancy after the fetus has been conceived. And this affects a majority of women who are of an older age, of advanced maternal age. So really age 35 is a time period when people who do become pregnant are really at risk of down syndrome and chromosomal problems.

ALISON ST. JOHN: I understand that about one of every 30 babies born in the United States has a birth defect. That seems pretty high. Is that what you're seeing in your health center?

GUERRERO: That's a national average. And we do see a little bit less prevalence in our community here down in San Ysidro. And that's because a large majority of our patients are of a younger age. So with a younger age, your chances of having a healthy, normal pregnancy are much better. So I can't give you an exact number for how many we do see, but it is less than the national average because we have a younger type of population.

ALISON ST. JOHN: So perhaps I trend in the nation for people to have babies later might be one of the issues.

GUERRERO: Absolutely, absolutely. A lot of women now are delaying their child bearing time to after the age of 40. And after the age of 40, just due to careers, changes, and other things happening, planning in your life, having a conception at that time or after the age of 40, you have a ten fold higher risk of something like down syndrome. So it is a much higher chance of that happening as you get older.

ALISON ST. JOHN: So that is something where, you know, the older women, I guess, needs to be taking precautions in some way to make sure that they have the best possible chance of having a healthy child. What are some of the risk factors that women need to be aware of it?

GUERRERO: So the -- one of the important things that we definitely try to push if my clinic and in many health centers like this is preconceptional counseling and care. And that's the period of time that you want to plan for a pregnancy. A large majority of pregnancies are unplanned, about half of them are unplanned in our country. And the other half are planned. So for those that are planned, those tend to go better in that they can reduce their chances of birth defects by taking in appropriate nutritional vitamins that we offer, the dietary changes, lifestyle changes, ark voiding things like tobacco and alcohol to try to reduce the chances that are going to impact you because you are older. So things like drug abuse, prior kinds of medical problems that are not controlled prior to conception, and of course the intake of prenatal vitamins are important to plan your pregnancy before you actually do conceive.

ALISON ST. JOHN: A lot of these things are just common sense, being healthy kind of things.

GUERRERO: Yes.

ALISON ST. JOHN: How does your center approach actually getting women to do this to prevent birth defects?

GUERRERO: We definitely encourage coming in once they become pregnant. If they get to that point, and hopefully it has been a healthy preconceptional time for them, to come in and get the prenatal care very early, within the first trimester, within the first three months of pregnancy. Because at that time, they can be set up are a whole gamut of follow up and testing that can actually screen for these problems when they're pregnant and can give them more information about their baby as it develops in the very first trimester. And our center does offer a lot of services below one roof. So we try to combine all services through health education that talk about cooking healthy foods to avoid, what kinds of vitamins to take to being able to get them into state programs where they can be screened for certain kinds of birth defects, and we have a wide spectrum of providers here from counselors to nurses to physicians that offer these things in a combination package that put it all in one place.

ALISON ST. JOHN: What about obesity? We've heard a lot about the problem of growing obesity in children, but can obesity in mothers lead to birth defects?

GUERRERO: Yes, it can. And one of the things that we see is that people who are obese are often diabetic, or they become diabetic, and they're at a higher risk of getting diabetes. Diabetes itself with a high amount of glucose in the bloodstream that cannot be controlled or that is poorly controlled does affect the fetus. Especially in terms of cardiac or heart malformations and Mr. Bes with the kidneys, and things of that nature that definitely are a factor from poor glucose control and diabetes that is not well treated. So that's a definite problem that we are seeing. And as you know, obesity is on the rise in our country, and in San Diego. Of.

ALISON ST. JOHN: Yeah, that's a tough one to deal with. Have you got any success stories to tell us about how -- what strategies you use at your health center to --

GUERRERO: Absolutely, yes, we definitely try to push this. And one of the things that I have seen is with the information like if people learn that they have to get care prior to prenatal care, so again, that preconceptional counseling, that preconceptional care that we tell them about, when people are trying to become pregnant, they come and see us for a preconceptional visit, and we go over their entire health history, prior medical problems, types of medications they may be on, and we teach them what they can do to reduce their chances of having a birth defect. And in terms of obesity, I have one patient actually that I've been trying to get pregnant for several years, and because of a variety of other problems, she did -- was not able to succeed. When she came to me, she actually started to get this counselling that we're talking about in terms of weight loss, reduction, taking vitamins and healthy lifestyle and nutrition, and she actually lost about 60 pounds, right? And she -- about a year after having lost that weight and maintained it, she was able to conceive, and she's currently in her 28th week of pregnancy, and she's doing very well.

ALISON ST. JOHN: So in fact for some women, getting healthy in order to have of a healthy baby is really all about getting healthy themselves?

GUERRERO: Yes. We definitely like to say that prenatal care is a big factor in keeping a pregnancy healthy. But it's the time point that's before the actual pregnancy that you basically can get your body to a level or a status that you are gone be able to maintain that healthy pregnancy.

ALISON ST. JOHN: Yeah, that's a nice story with B that woman because, I mean, there are many women who are struggling to get pregnant and finding it's not possible. So that's an encouraging tale.

GUERRERO: Yes, and on the flip side of that too, once they become pregnant and if they are obese, they are at risk for things like high blood pressure. And that can definitely affect the fetus toward the end of pregnancy, and even the delivery outcome, so the obesity factor does affect you being able to get pregnant and maintain a healthy pregnancy so that you don't have those kinds of complications during and even at the end of your pregnancy. So it's a key to many things during the course of your pregnancy.

ALISON ST. JOHN: So diabetes is an issue. But then gestational diabetes, explain what that's about. Of.

GUERRERO: Yeah, so there's basically two types of diabetes, the first we've already sort of hit on, and that's pre-gestational. So that's the diabetes that you have when you're not pregnant. You already have it as a medical condition, chronically. Of and that needs to be controlled with medication and diet as well to reduce your chances of having high glucose, 'cause that will affect you in becoming pregnant. Of but gestational diabetes is a separate problem that actually occurs when you become pregnant. And it develops with time. And as you are pregnant, your body's not able to tolerate or handle some of the glucose with your diet that you would have if you're not pregnant. So your body has less ability to manage glucose changes and some women that bee see cannot handle that, so they become a gestational diabetic and those can be controlled initially with diet and monitoring. Some of them do require some kind of medication at some time in pregnancy in order to maintain better control because we want to try to reduce that effect of high glucose which may harm the fetus with things like cardiac defects and things that may happen of that nature because the glucose is not well controlled throughout the pregnancy.

ALISON ST. JOHN: Listening to you talk, I sort of realize how important it is to get women to come in to be checked, you know, as they're going through this. Are you seeing a higher incidence of gestational diabetes developing these days.

GUERRERO: It has gone up in terms of a national trend. That's because of the obesity problem. The obesity is definitely associated as a risk factor for gestational diabetes. So as the obesity trends do go up, we definitely see sort of a parallel trend in gestational diabetes. And you're right. The healthy care prior to becoming pregnant is definitely key to preventing a lot of these problems.

ALISON ST. JOHN: Do you have problems getting women to come in? I mean, healthcare reform may be making it easier. I don't know if you've seen any changes in terms of the number of people who come in for help to your clinic.

GUERRERO: Yes, we work at a community health center which definitely is one of the places that people are -- that they know about as a place of access. And I think the access to care, at least as a starting point, is important for people to be aware of. And our center definitely promotes all comers. We do our best to see patients of all ages and backgrounds and at different ranges in their pregnancy from, you know, at the beginning at four weeks to 35 weeks so we encourage people to come in at whatever point is possible. And even though the insurance can be a barrier sometimes, we promote the fact that we will see you and we will help you with -- there are many kinds of programs and resources to get people through the door. To get them started. So that should not be a scary factor or a thing that prevents them from coming because we definitely have ways to help them once they come through our doors. So once they're here, we try to keep them and give them what they need. Because that's one of the things that I have to just be aware of to know to start to ask the questions somewhere.

ALISON ST. JOHN: We're speaking with doctor Jacqueline Guerrero who's an OBGYN at San Ysidro Health Center about how to avoid birth defects. And apparently the Center for Disease Control lists folic acid as a major preventer of birth defects.

GUERRERO: Absolutely. So this came about probably about the late 19 -- I'm sorry the beginning of 1990s where we saw an association between decreased folly intake and neural tube defects. And those are the defects I previously spoke about where the neural tube at the beginning of pregnancy does not close appropriately. And that can lead to problems with the brain and spinal cord as the fetus develops. So folate was actually found to be one of the key factors in terms of the metabolism and the formation of a neural tube at the beginning of pregnancy to promote that closure and a healthy development of the brain and spinal cord. So after many, many studies, we did note that a certain level of folate was needed to allow this process to occur correctly. And the currently -- the recommendation by the CDC and the FDA is 400 micrograms of folic acid per day for anybody who desires conception. So again, preconceptional, the intake of this is important, once a day.

ALISON ST. JOHN: What exactly -- is it something that appears in our diet or do you have to take it as a supplement?

GUERRERO: Before all these studies came out in the 90s, folate was not something that was commonly put or that we had in our food as fortification. It is in things like spinach and green peas and broccoli, but as you know, a lot of people don't eat this kind of food. So once we found out that there was a direct link to folic acid intake and a neural tube defect, the FDA in 1998 actually mandated that bread and cereal types of food be fortified with folate. And we began to put this amount of folic acid into in a prenatal vitamins. So people could reduce their change of having a neural tube now, having the correct intake may not completely take away the chance or risk of being a neural tube defect, but it definitely will reduce your rate or chances of having that in your fetus.

ALISON ST. JOHN: Okay. Well, doctor Guerrero, thanks so much for giving us some tips on things that can be done to help mothers have good, headlight babies.

GUERRERO: Absolutely. Thank you very much.

ALISON ST. JOHN: That was doctor Jacqueline Guerrero, OBGYN at the San Ysidro health center. And stay with us this year. Coming up, it's a full hour about theatrical productions here in San Diego.