Birth Defects and Ethical Considerations
Definition of a birth defect: Abnormal development of the fetus resulting in death, malformation, growth retardation, and varied functional disorders.
NOTE: All statistics used in this subject area are very suspect. For one thing there is a complete shortage of reliable data on this subject. No one, including the state and federal governments seem to be very interested in gathering a reliable body of facts, much less using them to prevent this expensive carnage from running out of control.
There is clearly much more interest in making money from “treating” these problems than in analyzing or preventing them in the first place. Another source now states that we have 7.5 million mentally impaired persons in the US today, out of which 200,000 are institutionalized. So these different figures are thrown around such that all of them must be taken with a grain of salt. One thing is for sure, we have a gigantic horrifyingly expensive problem that is growing by leaps and bounds that no one is seemingly taking a hard accurate look at, or proposing any long terms solutions for. But regardless of the world of shaky statistics, here goes with some more:
150,000 babies are born yearly in the US with birth defects, which is 3% of all births, but this jumps to 7% 350,000 by 1 year, and 14% 700,000 by school age. Carried out, this is 7,000,000 birth defect children in just 10 years, and 35,000,000 (35 million) in just 50 years. This mean that within the normal lifespan of an average individual about 50 million birth defect children will be born in the US alone.
10% of problems seen at birth can be traced to a specific agent (environmental agent, drug, biologic, or nutritional factor).
20% are inherited or associated with chromosomal changes.
70% are of unknown etiology.
25%, according to the General Accounting Office, are induced by environmental pollution.
1.4 billion is the annual cost of care for children with disabilities resulting from birth defects. This is a very low estimate.
A few types of birth defects have decreased, mainly through preventive methods, but many more have increased. According to CDC, of 38 types of birth defects 1979-89, 27 had increased, including several cardiac defects, chromosomal defects such as trisomy 18, and fetal alcohol syndrome; 9 remained the same; and only 2 had decreased.
Birth defects, including low birth weight babies, are the leading cause of infant mortality and is associated with significant risks of crebral palsy, mental retardation, retinopathy or prematurity, bronchopulmonary dysplasia, cerebral hemorrhage, deafness, autism, and epilepsy.
Causes and consequences of LBW and birth defects are varied and many are overlapping. Among them are poor nutrition, teenage pregnancy, premature birth, drug and alcohol use, smoking, and STDs. But statistics on this subject are very poor and very unreliable, and mistakes are common in interpreting the few statistics we have. For example, just because some number of teen age mothers bear birth defect and LBW children does not necessarily mean the cause is their status as teens, but may well be because of other risk factors in their life styles and make-ups. There may be nothing unhealthful at all about teen age pregnancies, absent other factors. Thus teen pregnancy itself, as such, may be getting unfair blame. We know the rooster crows at sunrise, but that doesn’t mean the rooster causes the sun to rise. Hospital-related costs for LBW infants in 1990 totaled over $2 billion, at an average of $21,000 per infant. This made up 57% of the total cost for all newborns. These are conservative figures and we know they are climbing at an exponential rate.
Smoking Moms constitute 25% of all pregnant women in the US. If smoking during pregnancy were eliminated, infant mortality could be reduced by 10%, and LBW babies by 25%. Women who smoke double the risk of having a LBW baby. The health care costs during the first year of life for infants born with LBW attributable to maternal smoking totals more than $1 billion. Smoking during pregnancy also is closely associated with premature birth, increased respiratory problems in infants, and Sudden Infant Death Syndrome (SIDS).
Fetal Alcohol Syndrome (FAS) is characterized by growth retardation, cerebral involvement, and facial abnormalities, and is the leading preventable cause of birth defects and mental retardation. It occurs in 3 infants per 1000 births, and for every child born with FAS, 10 more suffer from further alcohol-related problems. Minor or major abnormalities can be seen in about one-third of the infants born to women who drank heavily during pregnancy compared to 9% for nondrinkers. (Heavy drinking is defined as an average of 1 oz. or more of alcohol per day.) One thing we need is a complete reexamination of the human and economic costs our Social Drinking Culture, a killing culture that is sanctioned by law and society.
Teenage Pregnancies in 1989, accounted for approximately 500,000 births or about 13% of all births. Another half-million teenage pregnancies resulted in abortions, miscarriages, or stillbirths. Teenage mothers are also more likely to get inadequate prenatal care, be poor, have LBW babies, and suffer from alcohol or drug use, and a nutritionally inadequate diet. All of these factors are associated with infant mortality and LBW. Again, the problem is these other factors not the simple fact of a teen having a baby. If the teen doesn’t have these other factors her baby is more, not less, likely to be a normal baby than her older sisters. Again, poor statistics and record keeping as well as commonly poor analysis of the available data produce terribly inaccurate conclusions.
Drug Abuse by 1 in 5 pregnant women, costs the nation a half billion dollars a year for Cocaine users alone. There are about 9,000 births per year to narcotic-addicted women.
AIDS infects 1.5 per 1000 women giving birth in 1989. One-third of babies born to HIV-positive mothers will develop AIDS by 18 months of age, and AIDS is the ninth leading cause of death for children 1-4 years old, and it is increasing.
Current Birth Defect Monitoring Systems are completely inadequate, yet hold the most promise of reducing this economic and human cost. Unfortunately, few states have birth defect monitoring systems. Those states that do have programs include California, Iowa, New York, Texas, and Georgia, but even they are inadequate. They suffer from delays in ascertainment, investigation, data entry, and analysis. On a national scale, the Birth Defect Monitoring Program, in operation since 1974, currently accesses only hospital discharge summary data, and only on about 20-30% of U.S. births each year. So, the Federal Government is not much help here either.
Conclusion: Like so much of the rest of our health care system, there is very little interest in gathering good statistics or in prevention generally. Every focus seems to be on the money to be made in “treating” problems after they occur, rather than the lesser amount of money to be made in gathering good data and using it to prevent these human and economic costs.
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