National Birth Defects Prevention Month

The focus this year during January, National Birth Defects Prevention Month, is on the judicious use of medicines before, during and after pregnancy.

That goes for prescription and over-the counter drugs, as well as herbal remedies and dietary supplements.

Perhaps two-thirds of women use some kind of medication during pregnancy, according to the Centers of Disease Control and Prevention in Atlanta, Ga. Yet many of the effects of these drugs are poorly understood.

Pregnant women are often excluded from drug trials because of concerns for their unborn babies. As a result, we often know little about how drugs will affect fetuses.

Birth defects affect about 3 percent of babies born in the United States and cause more than 20 percent of infant deaths, according to the CDC.

Babies, stay put!

November is Premature Birth Awareness Month at the March of Dimes, part of an effort to bring down the appalling rate of premature birth in this country, where every minute a baby is born before its time — one in every eight babies born — for a total of 543,000 every year. That's almost 1,500 premature babies born every day, 13 of whom die from complications.

Premature birth — any one that takes place before 37 completed weeks of pregnancy — is the leading cause of infant mortality throughout the world. Babies even a few weeks premature can have health problems that will stay with them for their lifetimes.

In the United States, the rate of premature birth has risen 30 percent in the past 30 years. However, after peaking in 2006, the rate has begun to come down. The March of Dimes thinks its campaign, begun in 2003, had a hand in the decrease.

Premature babies can cost 10 times more to care for than babies born after 37 weeks — $32,325, compared with  $3,325 for full-term infants. The total cost of preterm birth in the United States is $26 million, according to the March of Dimes.

The organization hopes to bring premature births down with increased education for moms and health-care providers, prenatal care and research through its Prematurity Research Initiative.

On Wednesday, Nov. 17, the 8th Annual Premature Birth Awareness Day, the Empire State Building in New York will shine purple, the color assigned to this effort by the March of Dimes.

$1.5 billion from the Gates Foundation

The Bill & Melinda Gates Foundation this month committed $1.5 billion over the next five years to support programs that will work to improve maternal and child health, family planning and nutrition in developing countries.

Bill and Melinda Gates

Melinda Gates announced the  plan on Monday at Women Deliver 2010, a gathering of world experts, advocates and policy makers in Washington D.C.

“In poor countries, pregnancy and childbirth often end in tragedy. Our goal must be to build a world where every birth brings joy and hope for the future,” Gates said.

Gates said that the money will be used to support local efforts toward a comprehensive approach to health that will include family planning, prenatal care, nutrition and improving the conditions under which women give birth.

“Every year, millions of newborns die within a matter of days or weeks, and hundreds of thousands of women die in childbirth,” said Gates. “The death toll is so huge, and has persisted for so long, it’s easy to think we’re powerless to do much about it. The truth is, we can prevent most of these deaths – and at a stunningly low cost – if we take action now.”

Gates said, “Most maternal and newborn deaths can be prevented with existing, low-cost solutions – such as basic prenatal care, or educating mothers about the importance of keeping babies warm,” said Gates. “Countries that have made women’s and children’s health a priority – and have invested in proven solutions – are achieving amazing results.”

Researchers at the Institute for Health Metrics and Evaluation at the University of Washington say that maternal mortality has fallen more than 35 percent since 1980, from more than 500,000 maternal deaths to about 343,000 in 2008, according to a press release from the Gates foundation.

Deaths among children younger than 5 are also down dramatically. About 7.7 million children are expected to die this year, down from 11.9 million in 1990, and 16 million in 1970, the release stated.

The Bill & Melinda Gates Foundation, one of the world's largest philanthropic entities, is a "family foundation driven by the interests and passions of the Gates family," according to its stated principles. The foundation seeks to impact a number of major global issues, including health and education.

Bill Gates, founder of the Microsoft computer software giant, co-chairs the foundation with Melinda Gates and his father, William H. Gates Sr.

Photo by Kjetil Ree / www.commons.wikimedia.org

The mother of the Apgar score

Virginia Apgar MD devised the simple observational test that bears her name after watching doctors swiftly give up on struggling newborn babies, leaving them to die, Atul Gawande writes in his book, Better. At the time, a few years after World War II, one in 30 births in the United States ended in the infant’s death.

Virginia Apgar

Dr. Virginia Apgar

The Apgar score, introduced in 1953, is a 10-point scale for assessing how a newborn baby is doing — first with the birth process, and then with adjusting to the world. It is given in hospitals one minute after birth, and again at five minutes. A robust baby might garner 10 points, but a baby with an Apgar score of four or less draws serious concern and, likely, vigorous intervention.

Dr. Apgar’s scoring system transformed delivery, Gawande writes. “Even if only because doctors are competitive, it drove them to want to produce better scores—and therefore better outcomes—for the newborns they delivered,” he writes.

The daughter of a Westfield, N.J., insurance executive, Dr. Apgar graduated from Mount Holyoke College in 1929, and began medical school at Columbia University’s College of Physicians and Surgeons, where eight of her classmates were women and 81 were men. She began a surgical residency but, in the depths of the Great Depression, decided it might be difficult, especially as a woman, to make a living as a surgeon.

Dr. Apgar enrolled first in a course for nurse-anesthetists and then in Dr. Ralph Waters’ seminal residency program in anesthesiology at the University of Wisconsin in Madison, followed by a stint with Emery Rovenstine at Bellevue Hospital in New York — strong training for the day.

She founded the anesthesiology program at Columbia’s College of Physicians and Surgeons. However, when the program became a department, Dr. Apgar was passed over for the job as chairman, in favor of a man. She did become a full professor, though — in itself an accomplishment at the time — and was a pioneer in obstetrical anesthesiology.

Dr. Apgar saw a number of birth defects during the thousands of births she attended, and in 1958 she went back to school in public health at Johns Hopkins’ medical school in Baltimore. In 1959, Dr. Apgar joined the March of Dimes in its campaign to eliminate birth defects.

Dr. Apgar never married. Her entire life, she was famous for intelligence, energy, empathy and a great sense of humor. She was still working on behalf of the most vulnerable babies when she died in 1974, at the age of 65, of liver failure.

Gawande’s chapter about Dr. Apgar, “The Score,” also ran in the New Yorker.

The Pregnancy Meeting

The Society for Maternal Fetal Medicine held its annual conference in Chicago last week, and I went to a few sessions. The physicians, who specialize in the health of mothers and their babies, spent up to six days in meetings, so I got a canape-size serving compared to theirs.

Research teams from all over the country, and from other countries as well, reported on their investigations into conditions that jeopardize mothers' and babies' health in pregnancy.  Several important findings came out of the meeting. Here are just a few:

* A simple new urine test with a cool name, the "Congo Red Dot Test," appears to be able to predict and diagnose preeclampsia, a condition that can kill mothers and babies, cause birth defects, and is a major contributor to pre-term birth. A research team from the Yale University School of Medicine found that the test accurately predicted preeclampsia in 347 women in their study. Preeclampsia symptoms include hypertension and protein in the urine. The condition affects 5 to 10 percent of pregnancies. It is commonly treated by delivering the baby.

* One of every three pre-term births is caused by a "silent" infection inside the uterus. Now it appears some women and babies are genetically more susceptible to inflammatory infections, according to a study led by Roberto Romero MD, Chief of the Perinatology Research Branch at the National Institute of Child Health and Human Development. The study won an award from the March of Dimes, a nonprofit group that works to prevent birth defects, premature birth and infant mortality.

At the SMFM meeting, the Yale U. School of Medicine also presented the results of a couple of other investigations that might lead to a decrease in preterm births as well.