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Melanie Cole (Host): Thanks for tuning into Back to Health, the podcast that brings you up-to-the-minute information on the latest trends and breakthroughs in health, wellness, and medical care.

Today's special episode is part of our Women's Health Wednesday Series, which features in-depth conversations with Weill Cornell Medicine's top physicians on issues surrounding women's health throughout the life course. Listen here for the information and insights that will help you make the most informed and best healthcare choices for you.

I'm Melanie Cole. And on this Women's Health Wednesday, we're discussing National Birth Defects Prevention Month. Joining me is Dr. Georges Sylvestre. He's an assistant attending obstetrician and gynecologist at New York Presbyterian Hospital Weill Cornell Medical Center. And he's an Assistant Professor of Clinical Obstetrics and Gynecology at Weill Cornell Medical College Cornell University.

Dr. Sylvestre, it's a pleasure to have you with us today. I'd like you to start by kind of reminding us about birth defects, the common ones that you still see today, really what we've been seeing in the trends over the last few decades.

Dr Georges Sylvestre: You know, the underlying birth defect rate for anybody who's pregnant, and I say that to all my patients, is about 3%. What's been happening in the last few decades, which is really wonderful, is that we have really developed ultrasound technologies and ways to detect them ahead of time if they happen. And another thing we've done is identify risk factors of birth defects that we can eliminate and decrease the incidence of these birth defects. Not only catch them when they arise, but also decrease the incidence of them happening.

Melanie Cole (Host): So, what do we know about the main causes? I know we've learned a lot over the last bunch of decades about some of those causes and even things that we know now can help prevent them. And we're going to get into those, but what have been the main causes of birth defects?

Dr Georges Sylvestre: It's a combination of many factors related to underlying health, medication, environmental exposures, genetics, some that we don't fully understand yet. Let's look at the most common birth defects that I see on a fairly regular basis, like cardiac defects, like heart disease, congenital heart disease is one of the main common ones; a very common one, spinal cord defect; one missing finger or limb, some brain anomalies, just to name a few. These are the ones that we see a little more frequently than others.

Melanie Cole (Host): So then, why is it so important for women to see a healthcare professional before becoming pregnant and certainly throughout the course of her pregnancy? Some women, even younger women think, "It's okay. I'm good. I'm healthy. I don't need to worry about these things." But there are things we've learned, right? So tell us a little bit about why it's so important.

Dr Georges Sylvestre: It's such a good question. The ideal time to seek prenatal care is before you become pregnant and most women do not do that. To have a preconception visit is so important. Why? Because a lot of women have underlying medical conditions, which can be tweaked a bit in order to have a better pregnancy.

The most common thing is let's say you take a medication while you're not pregnant. Some medications are safe, others are not. Let's look at the three more common examples of medication taking. A lot of women take meds to control the hypertension, diabetes, or more commonly to control depression and anxiety. A lot of options exist to take medications to treat these conditions that are actually compatible in pregnancy. So if you have a patient that comes for example on the valproic acid to control her seizure disorder or epilepsy, I'm going to say, "Well, I'm going to switch it to a safer alternative than valproic acid," and we go on. So doing these little steps before become pregnant can substantially reduce the risk of birth defects. So I really advise women who are actively trying to get pregnant to consult their physician first, especially when they have underlying condition.

Another example, let's say diabetes. uncontrolled diabetes is a major cause of birth defect. A woman who has uncontrolled diabetes has a 10% to 15% risk of a serious heart defect or spinal defect in the baby. If we can control the diabetes before she becomes pregnant, I can bring those risk down to the regular population, which is about 3%. So, review of the medication and review of the control of the actual condition may greatly help in reducing the risk of birth defects.

Melanie Cole (Host): So important for us to hear. Now, doctor, as we've learned about vitamins over the years, we've learned so much about folic acid and it's helped with prenatal situations. So tell us a little bit about why taking a multivitamin, a prenatal vitamin, is so important before and during pregnancy and any that are contraindicated that you'd like to discuss.

Dr Georges Sylvestre: Folic acid has been shown to reduce the incidence of a particular birth defect called neural tube defect or, concretely speaking, spinal bifida or anencephaly, which is absence of the brain. That's a very serious birth defect as you can imagine. So, because we've noticed in the '80s and '90s that taking folic acid reduces the incidence of these birth defects, the United States has introduced fortification in the food that we eat, like flour and cereal has introduced folic acid in those nutrients. So that and in combination with us recommending taking folic acid before attempted pregnancy, ideally three to four months before becoming pregnant, can reduce the risk of neural tube defects.

I got to say that most healthy people with a healthy diet don't need much in terms of vitamin supplements. And the vitamin industry is very unregulated. So you have to be careful about the vitamins, such as vitamin A. If you take it in excess, it can actually increase the risk of birth defects. So consult with your physician and buy vitamins. Take your folic acid. That's the best step to reduce your risk of neural tube defects specifically and possibly heart defects as well.

Melanie Cole (Host): That's such great information. Many people might not have known about vitamin A. So thank you for that. What does a woman need to know about taking her medication? Suppose she does have diabetes or she's on blood pressure medication or any of those other things that might come along with it. What do you want her to know about the safety of taking those medications during pregnancy and discussing this with her physician?

Dr Georges Sylvestre: That's very important, because some medications for diabetes and hypertension, which are examples you just brought up are safe in pregnancy and others aren't. So medications work very well to control high blood pressure, but are dangerous in pregnancy. So it's important to consult with a physician to look for an alternative, which is going to decrease your risk of birth defects and control your underlying medication if you had diabetes or high blood pressure.

Melanie Cole (Host): Now, as we're speaking about medications, we all know drinking during pregnancy is contraindicated. We are not supposed to do that. But in this very stressful time that we're in right now, doctor, a lot of people are on various and sundry antidepressant. What about those kinds of things if someone is prone to depression? And we also hear about postpartum issues after pregnancy. So what about those kinds of medications like Lexapro or Xanax or any of those? Are those safe during pregnancy? And what do we say to our doctors about that?

Dr Georges Sylvestre: For medications to control anxiety and depression, which are very common as you said for the reasons that we all know, the principle of using the lowest effective dose is the best. So consult with a physician about potential alternatives to medications that you're taking to control anxiety or depression.

So, it's best obviously not to take any these meds. But these are important medical conditions that sometimes psychotherapy or relaxation won't take care of. So sometimes you don't have a choice, but using a medication. So with your physician, you can choose the medication which is safest in pregnancy.

I'm not going to go into the details of the specific antidepressants, but I can tell you that there are some fairly safe antidepressant antianxiety medications that exist to treat this condition.

Melanie Cole (Host): What about infections? Obviously, I mean, COVID looming around in the room here, but what precautions can a woman take? You mentioned environmental exposure at the beginning of the podcast. What precautions can women take to limit that exposure to agents that could cause birth defects or infections that could cause birth defects? Tell us a little bit about what some of those are, what we can do to hopefully prevent that.

Dr Georges Sylvestre: Many little steps that I'll go through. One of them is vaccinations. So, COVID vaccination has been in the news a lot lately, but let's not forget that rubella and chickenpox were and are common infections that can cause birth defects. So get your vaccination before you get pregnant. So rubella and chickenpox vaccines are available widely. And, if you're not vaccinated and catch rubella, the chance of birth defects is significant. So know your status, get your vaccines up-to-date.

With respect to other infections, let's look at syphilis. Syphilis is a relatively common sexually transmitted infection in pregnancy and non-pregnancy that we screen for in early pregnancy specifically. So ideally, screen for syphilis before pregnancy, because syphilis can cause birth defect, one. And two, it's very easy to treat. So that's one other way.

Another way is to wash your hands. If you work in areas like in the healthcare or the childcare, a daycare center, cytomegalovirus is common. Cytomegalovirus or CMV is one of the most common causes of congenital deafness. So the way to avoid it, unfortunately there's no vaccine yet, but they're looking for one, is to wash your hands, wash your hands and wash your hands.

So knowing your status can help you to some extent before you try to get pregnant. See if have been infected with CMV in the past. But if you're not, you're definitely at risk of getting primary CMV in early pregnancy and that can be devastating. So, wash your hands if you work in these settings and try to avoid getting it.

Finally, if you talk about infections like Zika virus. We talked about the Zika virus so much in the years past. Now, it has been overwhelmingly more common to talk about COVID, but Zika is a serious infection that can cause really significant birth defects. So if you can avoid traveling in areas that's been infected with the Zika in the past or in areas where Zika is endemic.

Melanie Cole (Host): That's true. We did discuss a lot of that a few years back. Certainly been overshadowed by COVID, but so important, nonetheless. And before we get ready to wrap up here, what is the criteria, doctor, for testing for these defects? I mean, I had my first child at 36 and my second one at 38. So I had amnios for both. Tell us a little bit about the criteria for testing for these type of defects. When do you do it and with whom?

Dr Georges Sylvestre: At many stages in pregnancy, we have like the first two sonograms that you have. The one at the nuchal translucency, which has done at the end of the first trimester, and the one that you had around the time of the amnio around 18 to 20 weeks, will screen for birth defects fairly effectively. So that's one of the ways and we test everybody.

Certainly women that are of, like you said, advanced maternal age, women that are exposed to medications, women that have taken toxic medication, drugs, alcohol, marijuana, we haven't talked about it too much, but should be screened specifically with an early anatomy sonogram at 18 to 20 weeks.

Like I said, in early pregnancy, we screen for the presence or absence of infection like syphilis, sometimes toxoplasmosis. So if we have it in early pregnancy, sometimes treating those infections in early pregnancy can reduce the risk of birth defects.

Melanie Cole (Host): Wow, what an informative episode this is, and you're such a great educator and I can hear the passion in your voice. I just imagine you're a wonderful doctor for your patients. As we wrap up, what would you like couples planning on having a baby to know about National Birth Defects Prevention Month, your most important information and advice, doctor.

Dr Georges Sylvestre: So, first of all, since 50% of the pregnancies are unplanned in this country, let's make it a little more planned. Like I said, if all pregnancies were planned, we'd have less problem. And the important steps is consult a physician before you try to be pregnant, plan to be pregnant, want to be pregnant. Avoid taking medicines without consulting a doctor. Don't smoke, don't drink, don't use drugs, which can cause birth defects. If you have diabetes, have it under control. If you have hypertension, have it under control.

And one thing which is difficult to do is to lose weight, but obesity rates have been increasing the last few years. And decreasing your BMI might actually decrease the rate of certain birth defects. So stay healthy, exercise. Don't take medication without consulting. Take your folic acid. Get your vaccines up-to-date, okay? And avoid the infections to the extent that we can.

Melanie Cole (Host): What a comprehensive list that was. Ladies, you can write all that stuff down because you heard it here from the experts at Weill Cornell Medicine.

And Weill Cornell Medicine continues to see our patients in person, as well as through video visits. And you can be confident of the safety of your appointments at Weill Cornell Medicine.

Thank you so much, Dr. Sylvestre, for joining us today. And we're so glad that you joined us for Women's Health Wednesday. We hope you'll tune in and become part of a community and a fast growing audience of women looking for knowledge, insight, and real answers to hard questions about their bodies and their health.

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