Every year, over one in 33 babies born in the United States, arrives with a birth defect, a leading cause of infant mortality. Although much of the risk is due to genes and unidentified environmental causes, a new Centers for Disease Control and Prevention (CDC) study identifies a number of modifiable risk factors that operate among most women under age 50. The findings, published in the American Journal of Preventive Medicine, emphasize targeted public health measures and individual lifestyle decisions in lowering the risk for major birth defects.The CDC study examined data from 5,374 women between ages 12 and 49 who took part in the National Health and Nutrition Examination Survey between 2007 and 2020. Scientists zeroed in on five major risk factors that can be treated before or during pregnancy: obesity, diabetes, tobacco exposure, food insecurity, and low folate levels.The findings were dramatic. Almost 66% of the interviewed women possessed at least one of these risk factors, and 10% possessed three or more. Obesity had impacted approximately one-third of women, and around five percent had diabetes. Almost 20% were exposed to tobacco smoking, vaping, or second-hand inhalation. Food insecurity, which impacts nutritional intake as well as access to prenatal vitamins, had affected around seven percent of women. Most alarming, 80 percent of women lacked folate, or vitamin B9, a key nutrient in fetal development.The Role of Folate and Prenatal Nutrition in WomenFolate is also crucial to DNA synthesis, cell growth, and red blood cell production. During early pregnancy, lack of folate can interfere with neural tube formation, resulting in neural tube defects like spina bifida and anencephaly. The FDA has required folic acid fortification in enriched cereal-grain food since 1998, reducing the number of neural tube defects by an estimated 1,300 cases per year.Even after fortification, the CDC study showed that almost eight out of ten women were still below the 400 micrograms (mcg) of folic acid per day, even after supplement use. Only 13% were at the recommended daily dose, leaving millions of women at increased risk of avoidable birth defects. Natural foods that are good sources of folate, like leafy green vegetables, legumes, asparagus, avocados, broccoli, and fortified cereals, are still imperative to a balanced diet.Are Obesity and Diabetes The Hidden Threats Prior to Pregnancy?Obesity and diabetes became prominent factors in high risk. Both conditions can disrupt metabolism of nutrients, such as folate, and increase the risk of congenital heart defects, neural tube defects, and orofacial malformations in the fetal fetus. Obesity occurs in one-third of women of childbearing age, and close to five percent have diabetes, which includes undiagnosed or uncontrolled diabetes.Controlling these conditions with diet, physical activity, and blood sugar testing is an important part of preconception care. As the CDC's Dr. Wang said, "The risks can be reduced through measures such as taking the recommended 400 micrograms of folic acid every day, eating a good diet, exercise, and controlling blood sugar."How Tobacco Exposure and Smoking Affect Infant Health?Both active and passive tobacco exposure causes the introduction of toxins that raise oxidative stress and compromise nutrient intake. Almost 20% of the women studied had raised serum cotinine levels, indicating tobacco exposure. Previous studies have associated maternal smoking with preterm delivery, birth weight, stillbirth, and Sudden Infant Death Syndrome (SIDS).Food insecurity adds to these risks. Approximately seven percent of women indicated a severe problem in accessing healthy food. Malnutrition in the mother can lead to deficiencies in important nutrients, including folate, and can increase the risk of obesity or metabolic disease in the child as an adult. Restricted availability of prenatal supplements also adds to these risks, especially in low-income groups.How Lifestyle Risk Factors Increase Over Time?The CDC analysis also showed dramatic disparities. Although risk factors were less common among teens and young women in their early twenties, almost three-quarters of women 35 to 49 years old had at least one risk factor. Non-Hispanic Black women had the most burden, with 80% having at least one risk factor, followed by 62% of non-Hispanic White women. Economic status was another predictor, with lower-income women having more than one risk factor, such as food insecurity and low folate status.These disparities point to the importance of targeted interventions, such as affordable nutrition programs, smoking cessation programs, and preconception counseling, especially in communities with systemic barriers to healthcare.What Is Causing Birth Defects During Pregnancy?Although causes of the majority of birth defects continue to be multifactorial, researchers typically cite a combination of genetics, environmental exposures, and maternal health as the culprits. Approximately 25% of defects are caused by chromosomal or genetic anomalies, such as Down syndrome. Environmental conditions, such as infection, diabetes in the mother, inadequate nutrition, and particular medications, are responsible for approximately five to ten percent. The other 65% are thought to be caused by intricate or unexplained interactions between genetic risks and the environment.Obesity, diabetes, smoking, and folate deficiency can interfere with vital biological processes, such as the one-carbon cycle, which utilizes nutrients such as folate, vitamin B12, and choline to control DNA synthesis and cell division. If this cycle does not work, the development of the brain and spinal cord in the fetus can be impaired.Easy Steps Women Can Take to Reduce the Risks of Birth Defects During PregnancyPrevention is fundamental. Women preparing for pregnancy need to achieve a healthy weight, control blood sugar, not use tobacco, have regular intake of folic acid supplements, and eat well-balanced diet with high natural sources of folate. Public health initiatives that enhance access to healthy food and prenatal supplements are important, especially for women experiencing food insecurity.Health care professionals are responsible for risk factor screening, preconception counseling, and informing women of salutary measures to maximize fetal health. Even small changes in lifestyle, i.e., better nutrition, regular physical exercise, and the use of folic acid supplements, can decrease significantly the risk of severe birth defects.Birth defects occur in one of every 33 babies and are the cause of about 20% of infant mortality. They may be mild, like clubfoot or webbed feet, to life-threatening and severe, like anencephaly or Trisomy 13. Although genetics cannot be changed, the CDC report highlights that most women have modifiable risk factors that, when corrected, can reduce the risk of complications.Dr. Wang stresses, "Every expecting family wishes for a healthy baby and healthy pregnancy. When families and their healthcare providers understand the modifiable risk factors for birth defects, they can make data-driven choices that may result in healthier babies and pregnancies."