Birth defects are a leading cause of infant mortality, and the costs, both monetary and non-monetary, to individuals, families, communities and the health care industry are substantial. More than 10,000 infants in New York state, 3-5 percent of all live births, are born each year with a major congenital malformation. Because about half of all pregnancies are not planned, improving the health of women in their reproductive years before they become pregnant continues to be an important strategy to reduce birth defects as well as other adverse pregnancy outcomes.

The importance of optimal health for women of childbearing age prior to conception in the prevention of birth defects cannot be overemphasized. Achieving pre-pregnancy health encompasses such areas as: consuming 400 micrograms of folic acid daily: knowing one's family history; having a check-up from a health care provider prior to conception; seeking reproductive genetic counseling, if appropriate; managing chronic maternal illnesses such as diabetes, seizure disorders, lupus or phenylketonuria (PKU); avoiding alcohol, nicotine, and illicit drugs; ensuring that prescription medication and herbal supplements are safe at the time of conception and during early pregnancy; and avoiding harmful occupational and environmental exposure. In addition, avoiding infections and ensuring protection against domestic violence are also important elements of a woman's health prior to conception.

Of special interest during January is National Folic Acid Awareness Week, set for Jan. 8-14. Folic acid is a B vitamin that is used by the body to manufacture DNA. DNA is required for rapid cell division and organ/tissue formation in the developing baby. Approximately 130 babies born in New York state each year have neural tube defects, disorders of the development of the brain and spinal cord. According to the National Birth Defects Prevention Network, up to 70 percent of neural tube defects can be prevented if all women who can become pregnant consume 0.4mg/day of folic acid at least one month prior to conception and during the first trimester of pregnancy.

There are three ways women can get enough folic acid:

� Take a vitamin supplement containing 0.4 mg folic acid daily.

� Eat a fortified breakfast cereal daily that contains 100 percent of the recommended daily amount of folic acid.

� Increase consumption of foods fortified with folic acid.

Folic acid-rich foods include: fortified breakfast cereals; enriched bread; rice; pasta; and other grain products; orange juice; green vegetables; and legumes such as navy beans, kidney beans, lentils and garbanzo beans. A large glass of orange juice and a bowl of fortified cereal will provide 50-100 percent of the recommended daily amount of folic acid. There are several Internet resources related to preconceptional health and folic acid, however the information should not be used for diagnosing or treating a health problem or disease, and is not a substitute for professional care. Some sites are:

� International Clearinghouse for Birth Defects Surveillance and Research: www.icbd.org

� March of Dimes Birth Defects Foundation: www.modimes.org

� National Birth Defects Prevention Network (NBDPN): www.nbdpn.org

� CDC Pregnancy-Planning Education Program: www.cdc.gov/ncbddd/pregnancy

� American Academy of Pediatrics (AAP): http://aap.org

Elane Daly is director of Health and Human Services for Cayuga County. She can be reached at 253-1560 or cchealth@dfa.state.ny.us