Having a healthy, bouncy baby
Birth defects seem to be common in developing countries. Many birth
defects are difficult to manage due to high costs and lack of
facilities. Even with best of facilities many children with birth
defects end up with disabilities with burden to the society.
However, birth defects are preventable. Simple measures may help to a
great extent. A monitoring system of birth defects in the country will
be very useful to further evaluate this problem.
Having a healthy baby is the dream of any married couple. The nature
has taken all the necessary precautions to prevent a birth of abnormal
babies. The chance of having a healthy baby is very high as much as 95%.
But there are unfortunate stories where babies are born with various
types of birth anomalies. How can we minimise this chance?
The causes for birth anomalies have been recognised birth defects
could be prevented. Many of these preventive measures could be carried
out at personal level.
* Marry when you are between 20 and 30 years of age
* Avoid marring a close relative
* Check blood for Thalassaemia carrier-state while in the teens
* Get vaccinated against rubella when you are young
* Plan your conception
* Start taking folic acid vitamin before conception
* Avoid drugs, infections, chemicals and x-rays
* Make sure young girls get adequate diet
* Avoid pets, or make sure that your pets are not harbouring
toxoplasmosis, a disease that can cause birth defect in your baby
Marriage between 25 and 35 Epidemiological studies have shown that
the optimum age for marriage is between 20 and 30 years. Babies born
during this period have the best chance survival and being healthy.
Mothers of younger age tend to have smaller babies and the chances of
those babies to have complications in early neonatal period are very
high. Teenage mothers are still growing. During this period their
systems in the body is diverting its functions and energy for growth.
Additional demand of growing a baby will be a challenge.
Similarly mothers above 35 have a higher chance to deliver babies
with congenital anomalies. The best example for this is Downs Syndrome
well known as Mongolism.
Mothers above 35 have 1-2 % chance of having Down Syndrome while the
mothers below 25 have only 0.1 % chance of having Down baby. There are
many other similar diseases that can have higher incidence with age of
The advice is that it is better to marry during this age group
because the chances for having a healthy baby and successful pregnancy
out come are high. Don't delay the marriage unnecessarily. Postpone
having children until about 20 years of age even if you are married.
Marring close relatives
Genes that are embedded in the 23 pairs of chromosomes of our cells,
control almost all the functions in the body directly or indirectly.
These chromosomes are very important.
They come in pairs (duplicates), one from the mother and the other
from father. This happens at the time of conception; when a sperm from
the father joins with the ovum of the mother. This important event takes
place 14 days prior to the first miss of the periods of a mother in
pregnancy. This means two weeks before they knew that they are pregnant.
Babies can inherits a bad gene from one of the parent, and still
avoid malfunction of the body because genes provided by the other parent
could compensate for it. This system of compensating by one of the
parent works most of the time to minimise inherited diseases.
However this will break down when both parents are having defective
genes for the particular function. The chances of this happening are
high when both mother and father are relatives. Closer relatives have
even a higher chance of bad genes for the same function.
Therefore it is better to avoid marriages between close relatives
because both of them have a higher chance of having an affected baby
than a randomly met couple.
Thalassaemia, blindness, deafness and cardiac malformations are few
out of many examples that can be given.
This type of genes that can be compensated by having one gene is
called Autosomal recessive genes. Where as other type of genes that will
cause disease even if it is inherited from one of the parents is called
Autosomal dominant genes. There are some genes that are bound with X
chromosome called X linked genes or sex linked genes.
Males are having only one X chromosome. Therefore if the problem is
related to the X chromosome boys will get the disease unless the mother
provides them with a good X chromosome.
Prevention of thalassaemia
In Sri Lanka about 60-100 babies are born with thalassaemia every
year. This disease leads to premature destruction of red cells in our
blood. Treatment available is palliative and expensive.
A child with thalassaemia will have to have blood transfusions every
month for life time while taking injections to remove excess iron that
is accumulating in the body daily.
Lifetime cost is about 10-20 million rupees. Therefore prevention is
the best/only option for this illness. Prevention of this illness is
possible. This can be achieved by adopting simple principals of
genetics. Both parents have to be carries to give a birth to a child
Both the parents of all thalassaemia patients in our country are
thalassaemia carriers. If one of them was not a thalassaemia carrier,
baby wouldn't have got thalassaemia.
When the mothers are checked at antenatal clinics so many of them are
thalassaemia carriers, but all of them have healthy babies if the
husband is not a thalassaemia carrier.
Thalassaemia carriers will produce babies with thalassaemia only if
they marry another carrier.
If the carrier status is recognised and marriage with another carrier
is avoided, the disease can be prevented. It is simple and easy. All the
unmarried in the country should get his or her blood tested before
marriage for their own benefit.
Four percent of our society is thalassaemia carriers. Therefore at a
marriage there is a high chance of meeting male thalassaemia carriers
with a female thalassaemia carrier.
Twenty five percent of babies born out of this type of at risk
marriage will have thalassaemia major.
Risk of having a baby with thalassaemia could be brought down to zero
if a marriage between two carriers is avoided.
Detecting thalassaemia carriers is not that complicated or expensive.
This test is done at the teaching hospital, Ragama at present and will
be available soon in number of other centres soon. The test is called
HPLC and it will give the 100 % certain answer whether you are a
thalassaemia carrier or not.
However what is more important is to make sure that one of the
partner in the couple to be a non-carrier. Therefore if one of the
partners is not a thalassaemia carrier there is no risk for the
offspring and no need to do further test.
Vaccination against rubella
Rubella is an infectious disease by a virus, which comes just like a
cold with a rash and enlarged lymph nodes. This is a mild illness that
subsides on its own. However when a pregnant mother gets it, this virus
has the propensity to infect all the tissues of the baby in the womb.
Infections in the early pregnancy will have higher chances of severely
affected babies. These babies may develop blindness, deafness, heart
disease, brain damage and many other problems.
This disease is easily preventable by a vaccine for rubella. This
vaccine is given by government hospitals free. It is the duty of all the
teenage girls to get this vaccine so that we could eradicate
malformations due to rubella in our country. Mothers who have failed to
take this vaccine when they were young could still get it, with only
precaution of avoiding a pregnancy for three months.
Plan your conception
At the conception; the meeting of the male egg (sperm) and female egg
(ovum) takes place two weeks prior to the missed period, the first
signal of pregnancy. By this time the baby is 14 days old and having
about 120 cells formed into three layers.
Anything that could affect adversely on this very tiny fragile baby
would have done the maximum damage by the time you knew about it. This
is an important reason why you should plan the pregnancy. With planning
many adverse situations to the fetus, like infections, toxins and drugs
could be avoided.
Folic acid vitamin before conception
Folic acid is a water-soluble vitamin that is required for many
functions in the body. This vitamin is available in vegetables and green
leaves that we eat. However cooking could destroy this vitamin and make
the diet inadequate in folic acid. Therefore all the pregnant mothers
were given this vitamin when they are pregnant.
However our mothers start taking this vitamin when they are three
months advanced. By three months of pregnancy the baby is matured to a
great extent. Baby will have a head, eyes, ears, limbs, brain, spine and
all most all the parts of the body.
Therefore by this time any adversities due to vitamin intake would
have operated. To prevent this it is essential to start taking vitamins
before the conception when you are planning for pregnancy.
The vitamin folic acid has been used in China with tremendous success
(85% reduction) for prevention of malformation in the brain and spinal
cord, just in two years.
Folic acid is a very cheap drug that costs only 10 cts per tablet. It
has been estimated by the Birth Research Unit, Kandy that taking this
tablet alone could prevent nearly 1000 cases of malformed babies that
may be born in our country within next ten years.
For this great achievement what is expected from the society is to
plan their pregnancies and start taking folic acid vitamin before the
conception. It is cheap and freely available. Take one tablet daily.
"A woman can greatly improve the health of her unborn child by
reducing the risk of a neural tube birth defect by simply taking folic
acid before she becomes pregnant, "said Dr. Berry (who conducted the
research in China). "The formation of the spine where this birth defect
occurs is complete within the first 28 days of pregnancy - before many
women know they are pregnant. After this time passes, it is too late to
prevent the damage."
Avoidance of drugs, chemicals, x-rays
Any chemical can have adverse effects on our body. All the drugs are
chemicals. When the pregnant mother took these drugs or chemicals drugs
enter into the fetus. The fetus been very fragile at this very early
stage will have the worst effects. There are so many drugs well-known to
cause birth defects. Drugs taken for epilepsy, diabetics, skin
conditions and rheumatism are few to mention.
Avoiding infection can be done, simply by avoiding crowded and
contaminated places. But there are few specific problems with regard to
toxoplasmosis. Our cats and dogs harbour these organisms during their
breeding period. They excrete these germs in their excreta.
Don't get contaminated. Get your pets treated by a veterinary
surgeon.X-Rays are harmful to the fetus. The pregnancy is two weeks
advanced before anybody is aware of the pregnancy.
Therefore all the females should avoid x-rays during two weeks before
their period unless you are absolutely sure that you're not pregnant.
However your consultant may recommend x-rays with very special
precautions when it is essential.
In conclusion having a baby is a very special event in life. Plan it
well to make sure to have a healthy baby. Give special attention to
daughters' nutrition so that they will be healthy mothers one day. Give
them rubella vaccine.
Get all the children checked whether they are thalassaemia carriers.
Make sure to avoid marriages between two thalassaemia carriers. Avoid
infections, drugs and chemicals around time of conception and early
pregnancy. Maintain a good nutritional status before getting pregnant.
Get treatment for iron deficiency. Start taking vitamin folic acid if
you are planning for conception.
Attend antenatal clinics regularly.
Diet Extra: Controlling your hunger
Learning to manage your hunger is a very important key to staying on
a weight-loss plan long enough to lose the desired weight. Hunger is a
natural by-product of limiting your food intake, and it's very important
to learn the difference between true hunger and a psychological desire
to eat. Once you are able to identify these feelings, you'll need to
learn to control your responses to them.
The basic process of hunger can be likened to a traffic light: Green
means start eating, yellow cautions that you're nearing the fullness
point and red means stop. Our physiology is actually designed to give us
the green, yellow or red lights, which could theoretically end the whole
calorie-counting business in favor of simply eating according to
physical hunger and fullness.
Unfortunately, the practice isn't that simple. For one thing,
distractions get in the way of physical sensations. Though our body says
"green light," we might not be able eat at that moment. Often, people
eat when they are too hungry and continue to eat well beyond a
comfortable feeling of fullness. Doing this consistently can lead to
Satiety refers to how long you'll feel full. In other words, how long
the light will stay red before turning green again. Many factors
influence satiety. A long list of hormones and physical mechanisms
trigger hunger and satiety. For example, low blood glucose and a hormone
called neuropeptide Y (NPY) are thought to stimulate hunger.
Conversely, hormones such as serotonin and cholecystokinin (CCK), as
well as many nutrients in the blood, contribute to satiety. Despite the
laundry list of reactions that physiological hunger and satiety trigger,
appetite is what most often determines how much we eat.
Nearly everyone eats for reasons other than just being hungry. Some
people have learned to eat "by the clock," so they eat on a schedule
whether they are hungry or not. Others eat in response to mood: sadness,
anger, anxiety, boredom or happiness.
These triggers are types of psychological hunger, and they can be
very powerful cues to eat - and to overeat. This is why it is helpful to
keep a food journal and write down how you're feeling before, during and
after you eat for reasons other than hunger.
Mechanisms that control learning behavior vary. Hunger and appetite
are the big go signals; satiation and satiety are the main stop signals.
A useful scale to gauge your hunger by :
1. You're so hungry you feel dizzy and irritable.
2. You need to eat and you're having trouble concentrating.
3. You feel physical signs of hunger (stomach rumbling).
4. You're starting to feel like food.
5. You feel just right - perfectly comfortable.
6. You are comfortably full.
7. You feel a little too full.
8. You feel stuffed.
9. You're very full and might need to unbutton your pants or loosen
10. You feel intensely uncomfortable.
If you recognize that you often wait too long to eat or you often eat
beyond the point of comfort, you might gain some benefit by keeping a
written record of your own feelings of hunger, using this scale. Take a
look at what and how much you eat - when you are too hungry versus the
times you eat when hunger is just beginning. See if you can move your
eating schedule to accommodate your true need for food.
What else can you do?
* Eat protein foods at each meal. Protein acts as an appetite
suppressant to help control hunger pains.
* Avoid simple sugar foods. And if you do succumb to them, ensure
they are mixed with a meal.
* Eat smaller meals. Eating smaller meals more frequently will help
reduce the intensity of hunger pains and keep your metabolism revved up.
* Consume high fiber foods. At each meal, consume high fiber foods
first to fill your stomach and speed satiety.
* EXERCISE! It regulates appetite to control hunger and food intake
(not to mention burning calories and building muscle).