According to the National Institutes of Health, one out of 33 babies born in the U.S. has a birth defect. Birth defects are problems that occur while the baby is still in the womb and developing, typically in the first trimester. Some birth defects are mild, while other are serious. They may be caused by a genetic mutation or by environmental factors, like medications that the mother takes.

Other health issues can occur when a baby is being born. Complications of labor and delivery may vary from excess bleeding to asphyxia or premature labor. Problems of delivery can often be prevented, or they can be avoided by delivering the baby by a Cesarean section. Complications put both the mother and baby at risk and can potentially result in a permanent birth injury in the baby, or even the death of the mother, the baby, or both.

What Are Birth Defects?

A birth defect is any kind of health problem that occurs with a fetus while it is still developing in the womb. Birth defects are not uncommon and they most often develop during the first three months of a pregnancy. A birth defect is often a structural problem and in some babies it is easy to see, like a cleft palate. In other babies it may be an internal or sensory problem and not immediately obvious, such as a heart defect. Some defects are mild, and either can be corrected or will not affect a child’s life to a great degree. Others are more serious and some can be so severe as to cause the baby to die. As medicine and technologies have advanced, doctors are now able to detect and manage some birth defects while the baby is still in the womb.

Types of Birth Defects

There are many different kinds of birth defects, but some are more common. The most common type of defect is anything related to the face or mouth. A cleft palate and cleft lip are the most common of these. Known genetic or chromosomal defects are the second most common type of birth defects and the most common of these is Down syndrome.

Heart defects are the next most common, followed by musculoskeletal, stomach and intestinal, and finally eye defects. The most common heart defect is atrioventricular septal defect, which occurs when there are holes between the right and left chambers of the heart. Heart defects are serious and usually require surgery to correct.

The most common musculoskeletal birth defect is gastroschisis. This is a defect in the abdominal wall that causes the intestines to penetrate to the outside of the body, near the belly button. Surgery is needed to correct it. Also fairly common musculoskeletal defects are deformities in the limbs, which usually appears as a limb that is smaller than normal.

Another type of birth defect is an abnormality in the central nervous system. The most common of these is spina bifida. It occurs when the neural tube, which houses the spinal cord, does not close all the way during development. The result is that the spinal cord is usually damaged and this can have all kinds of effects ranging from mild to severe and including both physical and intellectual disabilities.

Causes of Birth Defects

While most birth defects occur in the first three months of pregnancy, they can happen at any time during gestation. The causes of birth defects vary and sometimes a cause can never be determined. Some have known, specific causes, like fetal alcohol syndrome which is caused by the mother drinking alcohol during pregnancy.

For birth defects without one clear cause it is likely that a mix of factors are involved, including genes, environmental factors, and behaviors. It is known that certain factors will increase the risk of a baby being born with defects: drinking, smoking, using illegal drugs, or using certain prescription medications. Medical conditions in the mother, like diabetes that is not well-controlled, also increase the risk. Older mothers also have an increased risk of giving birth to a baby with birth defects.

Prevention

Birth defects are not always preventable. Even with the most careful preventative measures and attention paid to the mother’s health and environment, birth defects can happen. Taking certain steps, though, can reduce the risk. These include not smoking, drinking or using drugs and keeping up with regular medical appointments. Mothers can also reduce the risk by taking at least 400 micrograms of folic acid every day. Women should also avoid any medications known to pose a risk to the fetus. It is also very important to maintain good health in the mother. Her health can impact the baby and cause birth defects.

Medications that May Cause Birth Defects

One highly preventable cause of birth defects is prescription medication. There are several drugs that pose a serious risk of causing birth defects when a woman uses them during pregnancy. Most of these carry warnings about the risk, but some did not receive warning labels until many women and their babies were already adversely affected.

One of these is Accutane, a medication that was made by a French drug company, Roche, and was approved for the treatment of severe acne in the U.S. in 1982. Although it was known that this drug could contribute to birth defects, and the U.S. Food and Drug Administration (FDA) required that it carry a warning label, many women using it gave birth to babies with defects. Successful lawsuits against Roche were filed by women who claimed the company didn’t do enough to warn them of the risks.

Antidepressants, like Prozac for example, are also known to carry a risk of birth defects. This can be very difficult for a woman who is suffering from depression and wants to have a child. The benefits of treating the depression with medication have to be weighed against the risk of birth defects. The risk is increased, but still an overall low risk.

Some medications used to treat seizures and epilepsy also carry a risk for birth defects. Depakote, for instance, has been shown to increase the risk of babies being born with spina bifida, skull and face defects, heart defects, and other birth defects. Some victims have successfully sued Abbot Laboratories over Depakote and birth defects, including a girl born with spina bifida who was awarded $23 million.

Diflucan—generic name fluconazole—is used to treat fungal infections. In 2011 the FDA issued a warning that the medication could cause serious birth defects, especially when pregnant women took higher doses of the drug. Diflucan causes specific birth defects, including joint deformities, bowed thigh bones, abnormalities of the face and skullcap, cleft lip or cleft palate, and heart defects.

Complications of Childbirth

Complications of childbirth include anything that goes wrong and poses a risk to the baby, the mother, or both. Common complications include an abnormal heart rate in the baby, labor that fails to progress, asphyxia, or lack of oxygen to the baby, excessive bleeding, and social dystocia, which can cause nerve damage when the baby’s shoulder gets stuck in the birth canal and the neck stretches abnormally. Other complications may include problems with the umbilical cord, premature labor, or abnormal positioning of the baby, like the breech position in which the baby’s feet are emerging from the womb first.

Birth Injuries

Complications during delivery can be very serious and even fatal. More commonly these complications lead to birth injuries. One of the most common of these is cerebral palsy. It results from brain damage caused by the baby not getting adequate oxygen. Cerebral palsy affects muscles and movements and is not curable. It may be mild or severe and debilitating. Other common birth injuries include brachial plexus injuries and Erb’s palsy. These can result from shoulder dystocia, as the baby’s nerves are stretched and damaged. The result is some degree of disability in an arm.

The Effect of Medications

Sometimes a woman may be given medications during delivery. Oxytocin—brand name Pictocin—for instance, may be given to induce labor, or narcotic painkillers like hydrocodone or oxycodone may be given to the mother to help manage the pain. While it may be deemed necessary to use drugs during delivery, there are risks that these can negatively impact the process of delivery or the baby’s health.

Pictocin, for instance, may cause the mother to have more contractions than normal, which can cut off blood supply to the baby, potentially resulting in asphyxiation. The excess contractions can also cause physical damage to the uterus and baby. Narcotics used to reduce pain for the mother can help delivery go more smoothly, but they also pose risks for the baby, including depressing respiration.

Fetal development, labor, and delivery are all complicated and many things can go wrong, even with the advances of modern medicine. A variety of factors may cause birth defects or complications of childbirth, and many of them are preventable. Medications can be particularly harmful and better warnings about the risks they pose need to be given to women so they can avoid using drugs that will harm their babies.