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BANGLADESH J CHILD HEALTH 2019; VOL 43 (1) : 49-58
Birth Defect and it’s Impact in Neonatal Health : A Review
M A MANNAN1, SHARMIN AFROZE2, SANJOY KUMER DEY3, SADEKA CHOUDHURY MONI3,
MOHAMMAD KAMRUL HASSAN SHABUJ4, ISMAT JAHAN4, SHAHJADI NASREEN SULTANA7,
MOHAMMOD SHAHIDULLAH8
Abstract
Birth defects are one of the leading causes of neonatal mortality worldwide. Every
year more than 8.14 million children are born with a serious birth defect. The risk
factors predictive of birth defects in babies vary from country to country even from
region to region. About 60% of the causes of birth defect in humans are still unknown.
However, in about 25% cases, the causes seem to be “multifactorial”, indicating a
complex interaction between genetic and environmental risk factors. Many studies
have been conducted to determine the association of various risk factors with the
incidence of birth defects. Most of them found significant association with maternal
age, parity, consanguinity, poor nutrition, life style factors, low socioeconomic condition
and many more. But still there is debate in certain issues like common type of birth
defect, specific age of mother for having birth defect babies, role of drugs during
pregnancy etc. With advancement of diagnostic tools, birth defects can be identified
both prenatally and post- natally. This helps further in decision making and planning
for both parents as well as physicians to provide accurate treatment in time. Major
birth defect babies require intensive care and more hospitalization. Often
multidisciplinary approach is essential for them. But till now birth defect cases are
neglected in society. Increasing awareness about maternal care during pregnancy,
educational programs on birth defect and the consequences of consanguineous
marriages need to be highlighted to decrease the incidence of birth defect and their
co-morbidities as well as mortality.
Key words: Birth defect, Congenital anomaly, Risk factors, Impact.
Introduction:
Birth defect is defined as structural or functional
anomalies (e.g. metabolic disorders) that occur
during intrauterine life and can be identified prenatally,
at birth or later in life.1 Birth defects are important
causes of childhood death, chronic illness and
disability in many countries. It affects approximately
1 in 33 infants and is the fourth most common cause
of neonatal mortality.2A good knowledge on birth
defect is essential to understand the aetiology behind
this in order to reduce its hazardous impact on
newborn.
1. Professor, Department of Neonatology, Bangabandhu Sheikh
Mujib Medical University, Dhaka
2. Assistant Professor, Department of Neonatology, Dr. M. R
Khan Shishu Hospital & Institute of Child Health, Dhaka
3. Associate Professor, Department of Neonatology,
Bangabandhu Sheikh Mujib Medical University, Dhaka
4. Assistant Professor, Department of Neonatology,
Bangabandhu Sheikh Mujib Medical University (BSMMU),
Shahbagh, Dhaka.
5. Medical Officer (on Deputation), Dhaka Mohanagar General
Hospital, Dhaka South City Corporation, Dhaka
6. Professor & Chairman, Department of Neonatology,
Bangabandhu Sheikh Mujib Medical University, Dhaka.
Correspondence: Dr Sharmin Afroze, Assistant Professor,
Department of Neonatology, Dr. M.R Khan Shishu Hospital &
Institute of Child Health, Dhaka, Bangladesh, Mobile:+88
01715579709, Email: mumu.sharmin8@gmail.com
Received: 26-10-2018
Accepted: 16-03-2019
Magnitude of Birth Defect: There has been a
significant decline in infant and childhood mortality
rates in most countries in the past two decades. This
has primarily been due to extensive and successful
use of immunization, control of diarrhoeal disorders,
acute respiratory tract infections and improvement
in health-care services through a focus on primary
health care.3 As a consequence; birth defects have
emerged as the major childhood health problem. An
estimated 2, 76,000 babies die within 4 weeks of birth
every year, worldwide, from congenital anomalies.1
Although the global incidence of birth defects is
estimated at 3-7%, the rate varies widely between
countries. In Bangladesh, twelve percent of all
50
BANGLADESH J CHILD HEALTH 2019; VOL 43 (1) : 50
neonatal deaths are due to birth defect which is
alarming and prompt measures should be taken to
address it timely. (Figure-1)
Fig.-1: Causes of Neonatal Deaths in Bangladesh
[Source: CHERG/WHO/UNICEF for distribution of
causes of neonatal death s (Published in Liu et al
2014)]
Types of Birth defect:
Birth defects or congenital anomalies are divided into
major or minor according to severity. Major defects
are structural abnormalities that have medical or
cosmetic consequence. They may require surgical
intervention like cleft palate and congenital heart
disease such as Tetralogy of Fallot. Minor defects
are anomalies with no medical or cosmetic
significance. They may aid in diagnosis or recognition
of a specific syndrome. Most of the minor
abnormalities are limited to the head and neck region.
Infants with three or more minor malformations are
at high risk for having a major malformation (20-25%)
and /or a syndrome.4
Major and minor birth defects are often part of
patterns like syndromes, associations, disruptions,
deformations and developmental field defects. A
syndrome consists of a group of anomalies that are
associated due to single or similar etiologies, with
known or unknown cause such as Down syndrome.
Associations are clusters of malformations that occur
together more frequently than occur sporadically, like
VACTERL association (vertebral, anal, cardiac,
tracheoesophageal fistula, renal and limb anomalies).
Disruptions are extrinsic events that occur during
normal development. Defect in amniotic bands can
lead to amputation of digits or limbs. Deformations
Birth Defect and it’s Impact in Neonatal Health : A Review
can occur when physical forces act upon previously
formed structures such as uterine crowding or
oligohydramnios that result in plagiocephaly or
clubfeet. A developmental field defect consists of a
group of anomalies resulting from defective
development of a related group of cells
(developmental field). In this condition, the involved
embryonic regions are usually partially related but
may not be contiguous in the infant like
Holoprosencephaly, affecting the forebrain and face.4
It is also important to understand that these different
types of birth defects may not be entirely mutually
exclusive.5
Classification System for Birth Defects: The most
popular classification system for birth defect till now
is the ICD (international Classification of Disease)
coding system. Most countries (117) use this system
to report their health statistics. The International
Statistical Classification of Diseases and Related
Health Problems 10th Revision (ICD-10) has
described Birth defects in chapter XVII (Q00-Q99)
which is titled as ‘Congenital malformations,
deformations and chromosomal abnormalities’ and
excludes: inborn errors of metabolism (E70-E90). It
has classified birth defects into several body systems
along with chromosomal abnormalities and for each
category there is a specific code.6
Patterns of Birth Defect: Regarding patterns of birth
defect it may vary from country to country even from
institution to institution depending on type of delivery
taking place, type of patients coming from a particular
region and availability of facility to detect birth defect
cases. In the previous studies defects of the central
nervous system were found predominantly in most
of the countries. Recently due to advancement in
diagnostic tools specially for bedside Echo availability,
cardiovascular defects are leading birth defects.
Francine R et al. and Singh K et al. found in their
study that cardiovascular disease (16.6%) was the
highest followed by Musculoskeletal system,
genitourinary system & others.7,8
Factors Responsible for Birth Defect:
Around 40% to 60% of congenital anomalies are of
unknown aetiology; 20% due to hereditary. Others
are due to genetic mutations, chromosomal
abnormalities and maternal illnesses, such as
diabetes or infection, or use of anticonvulsant or other
drugs (Figure-2). 9 Many studies have been
conducted to determine the association of various
51
Birth Defect and it’s Impact in Neonatal Health : A Review
6%
7.50%
5%
Unknown
ae ology
Heriditary
20%
60%
Single gene
muta on
Chromosomal
Fig.-2: Different Causes of Birth defect
risk factors with the incidence of birth defects. Most
of the studies were done in cross sectional design.
Few case control studies were also performed. Some
studies were multi centered and included admitted
newborns only where as others used all live born
and still born babies.
Maternal Factors: There are several risk factors
for birth defect worldwide which are more or less
similar. In a country like Bangladesh some additional
factors are high fertility rate, unplanned pregnancy,
consanguineous marriage, non adherence to
antenatal check up, poor maternal nutrition and high
carrier rate for hemoglobinopathies.
Maternal Age: Association of maternal age with birth
defect is considered as an important factor. Both
younger and older maternal age may pose increased
risks for birth defects. Limited data, however, exist
on this association. Young maternal age and poor
pregnancy outcome, including birth defects, is related
to biologic factors such as mother’s gynecological
immaturity and nutritional status.10 A cross sectional
study on birth defect in Mosul city by Taboo Z A in
2012 showed high incidence of birth defect in the
young age group (median maternal age at diagnosis
is 25 years). More consistent results have been
published with respect to the association between
young maternal age and gastroschisis.11-14
It is also widely recognized that older maternal age
is strongly associated with chromosomal birth defects
such as trisomies 13, 18, and 21.15 Several other
studies have observed an association between older
maternal age and non chromosomal birth defects like
neural tube defects, cleft lip or palate, congenital
inguinal hernia, and cardiac defects.11,16
Parity: Parity is a risk factor for birth defect. Previous
studies have shown conflicting results in relation to
parity as a variable. Aguiar et al. found a lower risk of
neural tube defect in children of multiparous
BANGLADESH J CHILD HEALTH 2019; VOL 43 (1) : 51
women17, where as Castilla et al. found a higher risk
with greater parity (three or more children).18 Many
studies observed that first birth is associated with an
increased risk of selected birth defects like congenital
hip dislocation and gastroschisis. Women having their
first birth had significantly increased odds of having
an infant with 24 of 65 categories of birth defects
when compared to women having their second
birth.19 This finding is similar with study done by
Fatema et al. in Bangladesh.
Consanguinity: Consanguineous marriages are
widely accepted and practiced globally. Bittles et al.
estimated that 20-50 percent of all marriages in many
regions of Asia and Africa are between first cousins.20
This doubles the risk of children being born with birth
defects.21 It is proven by many authors like that
consanguinity increase the risk of congenital
anomalies (p value <0.05).7
Poor Antenatal check up: Regular antenatal check
up can help in early diagnosis of birth defect cases
and termination of fetuses incompatible with life. But
in many countries like Bangladesh, mothers do not
come in regular check up. Fatema K et al (2011) and
Mashuda F et al (2014) have found that poor and
infrequent antenatal check up is a significant risk for
birth defect.22 In Brazil, data shows increased odds
of birth defects among newborns of mothers with few
or no prenatal visits during the index gestation.23 Low
socioeconomic and education status, hard to reach
health facilities definitely have impact on this account.
Lack of Periconceptional Folic acid: Folic acid is
essential for proper development of the neural tube,
which becomes the spinal cord and the brain.
Because the neural tube is completely developed by
the third to fourth week of pregnancy, before most
women realize they are pregnant, women need to
be taking folic acid every day before they become
Table-I
Clinical Markers of high Risk Pregnancy50
•
Advanced maternal age
•
Previous birth of a malformed fetus
•
Family history of a malformed fetus
•
Consanguinity
•
Exposure to drugs/ radiation
•
Maternal Diabetes mellitus
•
Bad obstetric history
52
BANGLADESH J CHILD HEALTH 2019; VOL 43 (1) : 52
Birth Defect and it’s Impact in Neonatal Health : A Review
Table -II
Antenatal screening tests for Birth Defects35
Trimester of pregnancy
Screening tests
Interpretation
First (11-13 weeks)
Maternal blood
• Human Chorionic- gonadotropin (hCG) If theprotein levels are abnormally
• Pregnancy associated plasma protein A high or low, thereCould be a
(PAPP-A).
chromosomal disorder in the baby.
Ultrasound
Second (15-20 weeks)
If extra fluid behind the baby’s neckchromosomal disorder
Maternal blood (Triple screen” or
“quad screen”)
AFP (alphafetoprotein),hCG, estriol,
and inhibin-A.
Anomaly scan
neural tube defects or
chromosomaldisorders such as
Down syndrome
All structural birth defect
Table-III
Screening and diagnostic tools used to detect Specific birth Defect51
Screen / Test
First Trimester
Second Trimester
Screening for Down syndrome
Nuchal Translucency (NT)
plus Maternal Serum Screening
(βHCG/PAPP-A) 9+0 to 13+6
weeks
Maternal Serum Screening (βHCG/uE3/
AFP) 14+0 to 20+6 weeks
Screening for neural tube defects Ultrasound from 12 weeks
Diagnostic testing tools for
chromosome abnormalities
and genetic disorders
Maternal Serum Screening (AFP) 14+0
to 20+6 weeks Ultrasound*
Chorionic Villus Sampling (CVS) Amniocentesis After 15 weeks
10 to 13 weeks
* Ultrasound can detect neural tube defects at any stage of the second trimester, but the planned time for
screening is typically at the routine morphology scan at 19-20 weeks
Abbreviations: β HCG, Beta human chorionic gonadotropin; PAPP-A, Pregnancy-associated plasma protein A; uE3,
Unconjugated estriol; AFP, Alpha-fetoprotein.
Table-IV
Commonly used sampling procedures for antenatal diagnosis
Procedure
CVC (Chorionic
Amniocentesis
Cordocentesis
>18 weeks
Villus sampling)
Timing
9-12 weeks (transcervical)
>12 weeks (transabdominal)
16-18 weeks
Risk
Fetalloss 3-5%, feto-maternal
hemorrhage and limb defects
Fetal loss 0.5-1%, feto-maternal
Fetal loss 1-5%
hemorrhage and respiratory problems
53
Birth Defect and it’s Impact in Neonatal Health : A Review
pregnant. Taking folic acid every day is also important
because half of all pregnancies are un- planned.
Some authors found lack of periconceptional folic
acid supplementation in 63.5% mothers.22,24
Maternal disease: Many maternal diseases may
occasionally lead to increased risk of birth defects
such as hypertension, diabetes, febrile illness and
hypothyroidism, but findings are not consistent.
Maternal Diabetes: Evidence suggests that infants
of diabetic mothers have higher malformation rates.
Multiple anomalies seem to be more common in
diabetic than non-diabetic infants. Caudal regression
has the strongest association with diabetes, occurring
roughly 200 times more frequently in infants of
diabetic mothers than in other infants. The teratogenic
mechanism in diabetes is not clearly understood.25
But according to Castilla et al. diabetes causes
embryopathy, resulting in malformations and
spontaneous abortions.18,23
Maternal Hypertension: Hypertensive disorders and
antihypertensive medication use in early pregnancy
have both been suggested to directly affect fetal
development through vascular disruption or other
teratogenic mechanisms.26 A number of studies have
explored whether the prevalence of specific birth
defects may be increased by hypertension or its
treatment. They found association of hypertension
with specific birth defects, like congenital heart
defects (CHDs),27-30 severe hypospadias, cleft lip
with or without cleft palate, gastroschisis, and
malformations of the central nervous system
(CNS).31
Hypothyroidism: Babies born to women with
abnormally functioning thyroid glands are at
increased risk for heart, kidney and brain damage,
as well as birth defects such as cleft lip and palate.
A study was conducted at Johns Hopkins Hospital
between 1994 and 1999 to see the incidence of birth
defect among women having abnormal thyroid
function. They found 18% had birth defects, ranging
from cardiac, renal and central nervous system
problems. But there are few similar studies in this
aspect.32
Maternal infection: Infection during pregnancy is a
major cause of birth defects accounting for 2% to
3%.TORCH, includes Toxoplasmosis, Other (syphilis,
varicella-zoster, parvovirus B19), Rubella,
Cytomegalovirus (CMV), and Herpes infections, are
BANGLADESH J CHILD HEALTH 2019; VOL 43 (1) : 53
some of the most common infections associated with
birth defect like microcephaly, congenital heart
disease and hydrocephalus.33 About 25 percent of
babies whose mothers contract rubella during the
first trimester of pregnancy are born with one or more
birth defects, named as congenital rubella syndrome
(CRS). Women who are infected with the rubella virus
during the first 11 weeks of pregnancy have an up to
90 percent chance of delivering a baby with congenital
rubella syndrome; whereas during the first 20 weeks,
the rate drops to 20 percent. But the number of babies
born with congenital rubella has decreased
dramatically since the introduction of the rubella
vaccine.34,35
Recently found that Zika virus that is passed from
the mother to fetus can cause severe birth defects,
including microcephaly and brain abnormalities. The
risk of these birth defects is 20 times higher in women
with Zika virus.36
Smoking and alcohol intake: Lifestyle factors have
drawn increasing attention due to their capacity to
influence the result of conception. Smoking has been
associated with cleft lip, cleft palate and alcohol use
with fetal alcohol syndrome. In developing countries
like Bangladesh, cigarette smoking or alcoholism are
not common for women, so evidence is not found.
Also there may be a possibility that mothers of
newborns with birth defects may attempt to protect
themselves by denying or underestimating their risk
behaviors during pregnancy, including alcohol
consumption and cigarette smoking. But in
developed countries it is one of the important risk
factors. Even passive smoking of mother can bear
the unborn baby at risk for problems. Hazem S M et
al (2012) has found passive maternal smoking due
to husband smoking is the second risk factor for birth
defect (more than 50% of patients).37
Drugs: Only about 1% of all birth defects are caused
by maternal drug use. ACE (angiotensin converting
enzyme) inhibitors, angiotensin II antagonist, alcohol,
cocaine, high doses of vitamin A, some
anticonvulsant medications and some thyroid
medications cause various congenital anomalies.38
Family history: A positive family history for birth
defects has been associated with an increased risk
of having another child with defect, with a recurrence
rate ranging between 2 and 5% and 1% for neural
tube defects and Down syndrome respectively.22,39
54
BANGLADESH J CHILD HEALTH 2019; VOL 43 (1) : 54
Low socio-economic condition: It is observed that
mothers who belong to low socio economic
background have increased risk of birth defect babies
due to poor nutritional status. In this group, ignorance
and lack of education is also common which leads
to in-frequent antenatal check up and delayed
diagnosis. Nazer J, López CJ, Castilla EE (2001)
found in their study that birth defects were more
among infants born at public maternity hospital than
private hospital.40
On the other hand, the lower prevalence of birth
defect in private maternity hospitals may reflect
behavior by women with higher socioeconomic status
(similar to those from developed countries), due
either to greater self-care and care for the infant or
termination of the pregnancy following intrauterine
diagnosis of a fetal malformation.41
Impact of Birth Defect:
Many studies stated that newborns with malformation
have an increased frequency of low birth weight,
prematurity, and anoxia. It emphasizes the fact that
these children require high level of care at birth, thus
justifying the need for reference units for such
cases.23
Prematurity and low birth weight (LBW): Birth
defects contribute to the occurrence of preterm birth
and LBW. Francine R (2014) found in their study that
congenital malformation was significantly associated
with relatively low weight of the baby (p=0.027). Some
other authors also found the same findings.7,42
In relation to birth weight, according to reports in the
literature, children with neural tube defects show an
increased proportion of low birth weight due to the
malformations themselves, as in anencephaly, or as
the result of their effect on fetal growth.17,44,46
Perinatal asphyxia: Major malformations leads to
intrauterine hypoxic state which ultimately turns into
perinatal asphyxia. Many studies found low 5 minute
APGAR score in birth defect babies like Nhoncanse
S C et al (2014) and Francine R (2014).7,45
Morbidity and mortality: Birth defects have gained
increasing importance due to both high mortality and
morbidity. Children with adverse outcomes require
intensive care in the first days of life and in some
cases admission to an intensive care unit, thereby
increasing the probability of diagnosing an anomal.
Serious birth defects can be lethal. According to
Birth Defect and it’s Impact in Neonatal Health : A Review
Chung & Myrianthopoulos (1987), the odds of a child
with a congenital malformation dying were 3.85 in
the neonatal period and 2.81 in the post-neonatal
period.49 Costa showed the same magnitude in
determining perinatal death (AOR = 8.47) as did low
birth weight (AOR = 8.78).23
Long Term Impact:
For those birth defect babies, who survive, these
disorders can cause lifelong mental, physical,
auditory or visual disability. 47-49 Developmental
disabilities include:
Nervous system or brain problems – learning
disabilities, mental retardation, behavioural disorders,
speech or language difficulties, convulsions, and
movement trouble.
Sensory problems - blindness, cataracts and other
visual problems, and varying degrees of hearing loss
including deafness.
Metabolic disorders – phenylketonuria (PKU) and
hypothyroidism.
Degenerative disorders – conditions that might not
be obvious at birth, but develop intellectual delay that
gets worse progressively. Examples are: X-linked
adreno-leukodystrophy.3
Diagnosis:
Birth defects can be diagnosed during pregnancy or
after the baby is born, depending on the specific type
of birth defect.
Prenatal screening:
During pregnancy, high risk pregnant women (Table1) are usually offered these screening tests to check
for birth defects or other problems for the woman or
her baby.50 These include maternal blood tests and
ultrasound (Table-2, 3).35 Ultrasound screening is a
very reliable tool for assessing birth defects. In a
major study on 5, 00,000 cases about 11,000 (2.2%)
were found to be malformed fetus with a range of
sensitivity from 14 to 85% (mean 45.5%). In another
study on 1, 70,000 pregnant women, 4000 malformed
fetus were detected with a sensitivity of 61%.51
Other tests:
If the result of a screening test is abnormal, diagnostic
tests are done to determine if birth defects or other
possible problems with the baby are present. These
diagnostic tests are also offered to women with higher
55
Birth Defect and it’s Impact in Neonatal Health : A Review
risk pregnancies. These are invasive procedures
which bear a potential risk for fetus (Table-4).
Postnatal diagnosis:
Certain birth defects might not be diagnosed until
after the baby is born. Major birth defects are seen
easily but for minor defects we have to examine the
baby thoroughly. Besides this, investigations like Xray, Ultrasonography and blood tests can help us to
reach a confirm diagnosis and to find out
associations. It also helps physicians to manage the
baby accordingly.
Treatment:
Treatment of birth defect babies often requires
multidisciplinary approach. Team members include
neonatologist, pediatric surgeon, pediatric
neurologist, pediatrician, nurses, physiotherapist,
dietician, social worker and some other people. But
proper counseling about the condition and its
consequences is a major challenge for the
physicians. Treatment consists of general supportive
care and specific treatment like surgery. In a study in
Bangladesh, authors found among admitted birth
defect babies 69.2% underwent surgery and 51%
operated cases died.52 Timely diagnosis and early
intervention along with adequate life support can save
many birth defect babies.
Prevention:
Though not all birth defects can be avoided, prenatal
care and awareness of past or current conditions can
help with prevention.
Prenatal Care:
Pre-conception counseling: it is a meeting with a
health-care professional of a woman before
attempting to become pregnant. It generally includes
a preconception risk assessment for any potential
complications of pregnancy as well as modifications
of risk factors, such as counseling on smoking
cessation, alcohol reduction and medications that
may compromise fetal development.53
Ensuring vaccination: Vaccines are an important
part of planning and having a healthy pregnancy.
Chickenpox (varicella) and rubella infections during
pregnancy can cause serious birth defects. If a
woman plan to conceive, she should get a varicella
or MMR vaccine, at least one month before getting
pregnant.
BANGLADESH J CHILD HEALTH 2019; VOL 43 (1) : 55
Care during pregnancy:
Folic acid and vitamin intake: Taking a daily
prenatal vitamin that includes at least 400 micrograms
of folic acid can prevent a variety of birth defects.
Efforts should be made to ensure that more women
use folic acid during the peri-conceptional period, as
the use of folic acid supplement has been linked by
several authors to a reduced occurrence of some
congenital anomalies.35
Control of diabetes before and during pregnancy:
Poor control of diabetes during pregnancy increases
the chances for birth defects and other problems for
the baby. It can also cause serious complications for
the woman. Proper control of diabetes mellitus before
and during pregnancy can help prevent birth defects
and other poor outcomes.54
Prevention of infection:
TORCH: Pregnant women should wash hands
thoroughly after contact with children’s saliva or
diapers, avoid kissing children younger than 6 years
old on the cheek or mouth and avoid sharing food
and drink with young children to prevent CMV
transmission. Those who are infected with the rubella
virus during pregnancy must be closely monitored.
Zika virus infection can be prevented by avoiding
insect bite by using insect repellant, wearing a longsleeved shirt and long pants when outside and
avoiding travel to areas with Zika virus.
Awareness of past or current conditions: If mother
previously had a pregnancy with a birth defect, it’s
important to find out the most likely causes because
it can help physician to plan preventive measures
for next pregnancy.
After Birth:
Early detection and treatment of birth defects:
can prevent stillbirth or physical and intellectual
disabilities. Surgery can also be used to treat many
birth defects, including cleft lip and palate and spina
bifida, sometimes even before a child is born. The
idea behind prenatal surgery is to limit long-term
damage through early intervention. Prenatal heart
and renal-tract defects are often treated surgically
while the child is still in the womb, providing
decompression and early correction for a better
developmental prognosis. Although gene therapy is
also a possible option for treating certain genetic
defects, it is not yet used on a wide scale.35
56
BANGLADESH J CHILD HEALTH 2019; VOL 43 (1) : 56
Planning measures:
Birth defects are far more common than people
realize. Many studies contribute to the planning of
measures in maternal and child health, with a focus
on resource allocation for prevention of congenital
malformations, both primary (health education),
secondary (adequate prenatal care with broad
coverage), and tertiary (organization of referral
networks).23
Conclusion:
Birth defects are not rare. In fact, the increasing
contribution of birth defect in neonatal mortality is
alarming. Risk factors vary from country to country
but some common causes need urgent attention like
improvement of nutritional status of teen age
population along with periconceptional folic acid
supplementation and ensuring regular antenatal
check up. Besides these, national policy and
awareness program on birth defect can reduce
incidence as well as impact of it.
Disclosure: The author reports no conflicts of interest
in this work.
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