Every parent’s wish is to birth a normal and healthy baby. Sadly though, birth defects do occur, even in medically-advanced Singapore. Indeed, babies can be at risk of developing either congenital or hereditary birth defects.
“A birth defect is defined congenital if it is present at birth, and hereditary if it has been inherited from one’s parents,” explains Dr Simon Ng, a paediatrician at Kids Clinic @ Mt Alvernia.
Dr Henry Cheng, an obstetrician and gynaecologist at SMG Women’s Health, adds that several factors can increase the risk of birth defects.
“An older mother generally has a higher risk of chromosomal abnormalities which can, in turn, result in birth defects,” he explains. “The risk increases exponentially when the mother is more than 35 years of age, but structural birth defects (not caused by chromosomal abnormalities) can occur in young mothers as well.”
Additionally, having a baby with a birth defect in one’s previous pregnancy increases the risk of defects in subsequent pregnancies. Infections such as Zika also increase risks, although such occurrences are often not as common.
Our experts give the lowdown on common birth defects in Singapore, treatment parents can explore, plus, advice for preventing defects from occurring.
“An older mother generally has a higher risk of chromosomal abnormalities which can, in turn, result in birth defects. The risk increases exponentially when the mother is more than 35 years of age.”
1. Cleft Lip or Palate
How the condition is detected: A cleft lip can be detected via an ultrasound scan, from the fourth month of pregnancy, Dr Cheng says. If the family has a history of cleft lip or the expectant mother has had a baby with cleft lip in a previous pregnancy, the doctor may take special note when they scan the foetus.
The paediatrician, who will examine the newborn after it’s born, will be able to identify the cleft lip or palate during the checkup.
Causes: Dr Cheng notes that while the condition is random, it may also be associated with chromosomal abnormalities.
Symptoms: Other than obvious physical signs, babies with a cleft lip or palate usually have feeding difficulties.
Treatment: Treatment depends on the extent of the defect as the cleft can be present on one side of the mouth, both sides of the mouth or even the lips, Dr Ng notes. More severe defects might require surgery, the plastic surgeon will decide when to operate on a case-by case-basis. Feeding intervention might also be necessary, where the mum will be taught how to use a special bottle to feed her baby.
How the condition is detected: Antenatal tests like ultrasound scans can check if feet are in the proper position, Dr Cheng notes. If not, the condition will be detected when the baby is born.
Causes: Clubfoot may be related to the position of the baby in the womb, restricting the growth of the feet. For example, it may occur if the baby is in a breech position or if there is a low level of amniotic fluid during pregnancy, Dr. Cheng says. It could also be due to chromosomal abnormalities.
Symptoms: The appearance of the foot. In more severe cases, clubfoot interferes with the baby’s ability to walk as he grows older, Dr Ng observes.
Treatment: Treatment options are dependent on the degree of the clubfoot. In minor cases, physiotherapy and stretching might be sufficient to correct it. Parents might also opt for casting (baby's foot is gently stretched and manipulated into a corrected position and held in place with a toes to thigh cast) along with physiotherapy and stretching. In rare circumstances, an orthopaedic surgeon might have to perform surgery.
3. Congenital heart defects
How the condition is detected: Dr Cheng says that heart defects can be detected through an ultrasound scan from as early as 11 weeks, and confirmed when the pregnancy is at 5 months. The heart defect may become more apparent as the delivery date draws nearer.
Causes: Heart defects may be genetic or happen out of the blue with no known cause. As the formation of the heart is very complex, he notes that it is actually the most common organ to have defects.
Symptoms: Babies with congenital heart defects may be born blue, also known as cyanosis. They might also have breathing issues, alerting the doctor to do further tests and X-rays, Dr Ng explains.
Treatment: In some cases, medication is sufficient to ensure that the heart functions properly. In more serious cases, surgery might be necessary.
Your little one is not defined or limited by their disability. Many children with birth defects go on to live successful and fulfilling lives. The ability to conceive and raise a child is also a blessing. So take heart, and remember to love your child unconditionally.
4. Spina bifida
Causes: Deficiency of folic acid, most often spontaneous with no genetic cause.
Symptoms: According to Dr Ng, a swelling in the spine may indicate the presence of spina bifida. Other symptoms could include tufts of hair, moles or fatty lumps near the spine.
Treatment: Treatment depends on the severity of the condition, says Dr Ng. Surgery might be necessary in most cases and depending on the type of spina bifida, other specialists such as neurosurgeons, orthopaedic surgeons or urologists might need to step in.
5. Limb anomalies (including arm/leg defects)
How the condition is detected: Ultrasound scans at around 4 months can pick up defects in the limbs. However, dwarfism can only be picked up at 7 months, when the growth progression of the limbs are significantly slower in comparison, Dr Cheng explains. Anomalies can also be detected during the newborn check.
Causes: As Dr Cheng points out, limb anomalies can happen as a result of an isolated incident or other genetic abnormalities. For example, abnormal palm creases could indicate Down Syndrome in the child.
Symptoms: Physical signs, such as if fingers or toes are more or less than 10, abnormally fused, too long, too short, or bent and cannot be straightened.
Treatment: Treatment is related to the type of limb anomaly. In some situations, surgery might be needed to improve the function of the affected limb. In cases where the defect does not interfere with the function of the limb, parents sometimes opt for an aesthetic doctor to improve the appearance of the affected limb, Dr Ng elaborates.
Dealing with birth defects as a parent
Although having a child with a birth defect may be heartbreaking and discouraging for parents, Dr Ng assures that, more often than not, birth defects can be corrected with treatment such as surgery or medication.
“In cases where the defect is not easily correctable, there are things that can be done to help reduce the impact of defects,” he adds. “One very useful thing for parents is support groups where they can pool resources to help one another, and find solace in the fact that they are not alone.”
Also, your little one is not defined or limited by their disability. Many children with birth defects go on to live successful and fulfilling lives. The ability to conceive and raise a child is also a blessing. So take heart, and remember to love your child unconditionally.
What can one do to prevent birth defects?
Dr. Cheng rounds up some steps mums can take ― both before and during pregnancy ― to lessen the likelihood of birth defects.
* Ensure that folic acid supplements are taken before and during pregnancy. Folic acid can decrease the chances of birth defects, particularly in the baby’s central nervous system.
* Practise good hygiene and infection control measures such as staying away from crowded places to avoid catching infections, or wearing a face mask when you are not feeling well.
* Getting regular antenatal checks during pregnancy so that screening tests, blood tests and genetic tests (eg amniocentesis) can be conducted early and where possible, complications managed in a timely fashion.
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