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Having a healthy, bouncy baby

by Dr. R.M. Mudiyanse, Consultant Paediatrician, Base Hospital, Mawanella

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 mother.

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 with thalassaemia.

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

by Dr. Nancy Tice

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 weight gain.

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 your belt.

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).