HEALTH / INFANT MORTALITY : More Research on Birth Defects Urged

Noting that birth defects remain the leading cause of infant mortality in the United States, the March of Dimes has called for increased research into their causes, expanded monitoring and improved access to maternity care.

The organization’s campaign comes as legislation is pending in Congress that would set aside funding to develop a plan for a national birth defects monitoring and research system and a national clearinghouse on birth defects research.

“Birth defects are the next horizon in the national effort to prevent infant mortality,” said Jennifer L. Howse, president of the March of Dimes. “Advances in medicine and technology . . . make it possible to save many babies from dying of infectious diseases or complications at birth. Now, birth defects are killing more babies than any other cause.”

The March of Dimes initiative comes as California’s budget crisis has forced the state to scale back its pioneering birth defects monitoring program, which has served as a model throughout the world since its inception in 1983.

Faced with a 47% cut in its $7.1-million budget, the program is ceasing operations in 45 of the state’s 58 counties. About 50% of all births in the state, in 13 counties including Los Angeles, will continue to be monitored.

At a news conference in St. Louis on Thursday, March of Dimes officials released a report showing that one in five, or 8,000, babies die of birth defects each year before reaching their first birthdays.

As many as a third of those might be prevented using available methods, experts say. For example, immunizations can prevent diseases that cause birth defects, women can be counseled not to take drugs during pregnancy, and exposures to hazardous chemicals can be reduced.

The March of Dimes called for an expansion of federally funded research into the causes of birth defects, using the rapidly evolving knowledge of genetics.

Finally, the group called for expansion of Medicaid coverage of health care for pregnant women and infants to enhance detection and treatment of birth defects as well as other causes of infant mortality.

Dr. Michael Kaback, chairman of the department of pediatrics at UC San Diego School of Medicine, said he hoped that the group’s campaign would help call attention to how developments in science are creating opportunities for reducing birth defects.

“One of the potential major pay-offs of this enormous technology, that the taxpayers have paid for, will be in the area of prevention, treatment and ultimately cure of birth defects,” he said. “However, that will not happen if the public remains ignorant of these issues.”

Kaback said the causes of birth defects are numerous. Some are environmental, such as infections. Some birth defects, such as those caused by drug use in pregnancy, come from the interaction of environmental and biological factors. Others, such as Down’s syndrome, are caused by genetic factors.

Diagnosis of birth defects in the womb has improved enormously over the past 20 years, creating possibilities for prevention and treatment, Kaback said. Genetic screening has also made it possible for couples to anticipate, or avoid, conceiving a child with a birth defect.

“There isn’t a single solution if we want to reduce infant mortality,” said Kathy Kneer, program director for the March of Dimes of California. “It’s not like polio; one vaccine won’t cure infant mortality. You need a medical model, a social model and a research model.”