March of Dimes recommendations for prevention of congenital anomalies

The core principals recommended by the March of Dimes for the care and prevention of congenital anomalies in the globe:

Experience shows that the care and prevention of birth defects are feasible and can be cost-effective. Such care and prevention requires comprehensive women’s, maternal, newborn and child health programs and provision of basic medical genetic services to ensure that people with birth defects or at reproductive risk of having children with birth defects can live and reproduce as normally as possible.

The following steps should be taken to prevent birth defects and improve the care of affected children in middle- and low-income countries. These steps can be implemented in two phases, according to the health needs and economic capacities of a given country.

Recommendations: Phase 1

• Educate the community, health professionals and workers, policy makers, the media, and other stakeholders about birth defects and the opportunities for effective care and prevention. To achieve this end, each ministry of health should designate an expert or an individual with responsibility for coordinating strategies for care and prevention. These strategies need to be woven into existing public health strategies. Ministries do not need to create a new position, but they should ensure that a knowledgeable, trained and effective person holds this responsibility.
• Promote family planning, allowing couples to space pregnancies, plan family size, define the ages at which they wish to complete their family and reduce the proportion of unintended pregnancies.
• Ensure a healthy, balanced diet during a woman’s reproductive years through an adequate intake of macronutrients (protein, carbohydrates and fats) and a broad range of micronutrients. Special attention should be given to adding 400 micrograms of synthetic folic acid daily to the diet through
  fortification and/or supplementation, while also promoting a diet rich in food folates; correcting iodine and iron deficiencies; and removing teratogenic substances, the most important of which is alcohol, from the diet.
• Control infections in all women of reproductive age.
• Optimize maternal health through control of chronic illnesses associated with an increased risk of birth defects. These include insulin-dependent diabetes mellitus, epilepsy and its control with anti-epileptic drugs; and heart disorders for which sodium warfarin is prescribed.
• Train physicians, nurses, allied health professionals and workers in the fundamentals of the recognition of causes and care of children with birth defects.
• Conduct physical examinations of all newborns by a physician, nurse or allied health professional trained to recognize birth defects before hospital or clinic discharge.
• Establish appropriate child health services to care for infants with birth defects.
• Establish national capacity for surveillance and monitoring of common birth defects to inform policy and to allow for more robust evaluation of national interventions, such as fortification of the food supply with folic acid.
• Promote lay support organizations, including patient/parent support groups, to improve patient care and birth defect prevention by facilitating community and professional education and advocating for increased funding for research on the causes of birth defects.

Recommendations: Phase 2

• Train physicians, nurses and allied health professionals in the essentials of medical genetics. This training should include the recognition of birth defects; means of treatment where possible in the primary health care setting; knowing when to refer a patient for more specialized treatment;
  basic genetic counseling, including best practices in communicating unfavorable health information to parents; and support for families who have a child or are at risk of having a child with a birth defect.
• Establish peri-conception medical services to assist women and their partners to attain optimal physical and mental health and well-being at the beginning of pregnancy to facilitate a normal pregnancy and delivery of a healthy infant. These include screening for the risk of genetic, partially genetic and teratogenic birth defects.
• Implement pre-conception or prenatal medical genetic screening to identify couples at risk of having a baby with hemoglobin disorders, Down syndrome, blood type incompatibility, congenital syphilis and congenital malformations, particularly neural tube defects.
• Establish newborn screening to identify congenital hypothyroidism, phenylketonuria, galactosemia, sickle cell disease, G6PD deficiency and other metabolic disorders.
• Educate the public about birth defects and the steps mothers and fathers can take with their health care provider to maximize the chances of a healthy pregnancy.

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