From antidepressants to Zika: COPH professor talks pregnancy and birth defects

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January is National Birth Defects Prevention Month

Birth defects are a huge public health challenge. According to the Centers for Disease Control and Prevention (CDC), every 4.5 minutes a baby in this country is born with a birth defect. In recognition of National Birth Defects Prevention Month, we posed some questions to USF College of Public Health’s Russell Kirby, a distinguished university professor of community and family health who has done extensive research on birth defects and adverse pregnancy outcomes.

Russell Kirby, PhD, MS. (Photo courtesy of USF Health)

Q: We know that folic acid, a B vitamin necessary for cell growth and development, is important for women before and during pregnancy. But with all the fortification of food—everything from cereal to tortillas—do women still need to take a supplement/vitamin with folic acid?

“I would answer yes, especially with the increase in things like low-carb and gluten-free diets [many fortified foods are wheat and grain based]. What’s more, most women who take folic acid during pregnancy get it in the form of a prenatal vitamin, and that vitamin can have a number of other minerals and nutrients necessary for the health of both baby and mom.”

Takeaway: The March of Dimes recommends women take a vitamin with 400 micrograms of folic acid daily before pregnancy and 600 micrograms once pregnant. Foods that are fortified with folic acid, or that contain it naturally, are breads, pasta, cereals, corn masa, beans, broccoli, eggs and citrus fruits. The organization states that if all women had adequate amounts of folic acid before and during pregnancy, up to 70 percent of neural tube defects (birth defects that affect the spine and brain) could be prevented.

(Photo source Google Images)

Q: That brings us to an interesting topic—wildly popular low-carb diets. Are women who limit their carbohydrate intake during pregnancy at an increased risk of delivering a baby with birth defects?

“If they are taking a prenatal vitamin and ensuring that they are getting basic nutrition and eating healthy, then I think they are probably fine. And if the low-carb diet can help them get to a healthy weight in preparation for pregnancy, then it might actually prevent birth defects. There is a lot of evidence showing that obesity—for reasons we don’t fully understand—can increase the risk of birth defects.”

Takeaway: Get to a healthy weight before you become pregnant. According to the American College of Obstetricians and Gynecologists, babies born to obese mothers are at increased risk for spinal tube defects and certain heart defects. They are also at increased risk for stillbirth and preterm birth. When you are pregnant (and even when you are trying to become pregnant) make eating healthily a priority and take a multi or prenatal vitamin.

(Photo source Google Images)

Q: Antidepressants are one of the most commonly prescribed drugs in America, says the CDC. Is there any link between antidepressant use during pregnancy and birth defects?

“That’s a question that’s still up for debate, but if we are talking about selective serotonin reuptake inhibitors (SSRIs), most are relatively safe and will not increase the risk of birth defects. Some have been implicated in causing congenital heart defects, but these conditions are very rare.”

Takeaway: If you take an antidepressant and are pregnant or contemplating pregnancy, speak to both your mental health care provider and OB/GYN for advice. If you decide to come off the medication, your doctor can suggest alternative treatments and give you guidelines on how to properly wean yourself from the medication.

(Photo source Google Images)

Q: The Zika virus and its effects on unborn babies caused some big headlines a few years ago. Is it still a concern?

“Yes, the Zika virus is still with us although it has gone off the radar a bit. We’re not sure why—perhaps the virus has mutated or perhaps we have put into place some good mosquito-control measures. In any event, it is still causing some major problems in Puerto Rico, South and Central America, Asia and Africa. And we don’t really know all the long-term effects of fetal exposure to Zika. We are getting reports of children now 2-3 years old who are just starting to show neurodevelopmental effects. It’s important to note, however, that most cases come from travelers into this country and are not from local transmission. Definitely still take precautions, though. Do what you normally do to protect yourself from mosquitos, and that includes using insect repellent.”

Takeaway: Limiting your exposure to mosquitos is your best defense. Wear long pants and long sleeves and use insect repellent when you are outdoors. Repellents containing DEET, says the CDC, are safe for both pregnant and breastfeeding women.

(Photo courtesy of USF Health)

View our Facebook Live interview with Dr. Kirby here.

Story by Donna Campisano, USF College of Public Health