'8m born with birth defects'

2006-01-31 12:48

Lauran Neergaard

Washington - About eight million children worldwide are born every year with a serious birth defect, many of whom die or are disabled - a stunning and largely hidden toll, says research released on Monday by the March of Dimes.

The March of Dimes is a charitable organisation that draws its name from the 10-cent US coin called a dime.

While birth defects are under-appreciated globally, most occur in poor countries, where babies can languish with problems easily fixed or even prevented in wealthier nations, the report found.

But the researchers said some innovative programmes in Iran and Chile show that effective preventions don't have to be costly.

Indeed, about 70% of birth defects could be either prevented, repaired or ameliorated, they concluded.

Birth defects 'can be prevented'

"We were surprised by the toll," said epidemiologist Christopher Howson with the March of Dimes, which sponsored the five-year project after doctors complained that birth defects often are ignored as a public health problem.

"Most people think of birth defects as something that is not preventable," said Dr Jose Cordero, the US assistant surgeon general and birth defects chief at the Centers for Disease Control and Prevention. "There are great opportunities to ensure that babies are born healthy."

About 7.9 million children a year are born with serious birth defects caused at least partly by a genetic flaw, such as heart defects, spina bifida and other neural tube defects, sickle cell anemia and Down syndrome.

Undoubtedly hundreds of thousands more are born with defects caused not by genes but by post-conception problems: mothers infected with rubella or syphilis, which can damage their babies' brains; certain medications or alcohol; lack of dietary iodine. But too few countries count those defects for a good estimate.

Poor health care a major factor

At least 3.3 million children under age five die each year because of a birth defect, and another 3.2 million are mentally or physically disabled.

Prevalence ranges from a high of 82 defects per 1 000 live births in Sudan to a low of 39.7 per 1 000 births in France. The researchers cautioned that the data isn't precise enough for detailed country-by-country comparisons - but cite poor maternal health care, a higher percentage of older mothers and greater frequency of marriage between relatives as leading risks in low- and middle-income countries.

Additionally, populations from Africa, the Eastern Mediterranean and Southeast Asia are most at risk of the common inherited diseases thalassemia, sickle cell and the metabolic disease G6PD, regions less likely to offer genetic testing that reveal at-risk couples.

Risks can change

The report takes no stand on abortion. But it also found that Down syndrome is roughly twice as common in poorer countries, which typically lack prenatal testing, while half of affected pregnancies in Western Europe are terminated following prenatal diagnosis.

Every mother-to-be has about a 5% chance of having a baby with a serious birth defect, the so-called "background rate", explained Dr Arnold Christianson of South Africa's University of Witwatersrand, who co-wrote the report.

That risk can rise or fall, depending on a host of circumstances. "If mom can be as fit and well as possible at the time of conception, it reduces the risk of a birth defect," Christianson said.

Among the report's recommendations:

-Improved health care for all women, with special emphasis on pregnancy nutrition.

-Improved family planning and birth-defect education. In Johannesburg, surveys show less than 40% of African women know what Down syndrome is, much less that their risk rises with pregnancies after age 35, Christianson said.

-Proper care of affected babies. In South America, for example, 55% of babies with Down syndrome die before their first birthday. Median US survival is age 51, up from age three in the 1960s thanks to improved care.

- AP