Planning a baby? Experts explain how antenatal care helps prevent and detect birth defects – Firstpost

The journey to parenthood is often paved with dreams of soft smiles and healthy milestones. Yet, for nearly 8 million families globally each year, that dream is met with the complex reality of a birth defect. In India alone, an estimated 1.7 million children are born annually with congenital anomalies, accounting for roughly 7% of all births and standing as the fourth leading cause of neonatal mortality.

While the term “birth defect” can carry a heavy weight of fear, modern medicine is shifting the narrative from one of uncertainty to one of proactive empowerment.

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The secret lies in the “Inverted Pyramid” of care, a clinical shift that prioritises the first trimester as the most critical window for intervention. Medical experts now emphasise that maternal health isn’t just a reaction to pregnancy; it is a foundation laid months before conception.

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From the simple yet transformative power of folic acid to advanced biochemical screenings that flag risks before they become crises, the tools to protect the next generation are more accessible than ever. By closing the gap between medical knowledge and public action, we can ensure that more children start life on a healthy footing.

Firstpost talked to Dr. Pallavi Gajakosh (Consultant - Fetal Medicine, Surya Mother And Child Super Speciality Hospital), Dr. Prachi Benara (Fertility Specialist, Birla Fertility & IVF), and Dr. Vadana Mittal (Senior Consultant - OBGYN, Paras Health) to explore the roadmap of prevention, the nuances of early detection and why regular antenatal visits are the single most powerful tool for an expectant parent.

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The scale of the konflikt

Globally, around 7.9 million children are born every year with birth defects, with nearly 94 per cent of cases occurring in low- and middle-income countries. India accounts for a significant share, with an estimated 1.7 million babies born annually with congenital anomalies, roughly six to seven per 100 births. Birth defects are also the fourth leading cause of neonatal mortality in the country, responsible for nearly 7.9 per cent of new-born deaths.

“These numbers are not just statistics. They represent families whose expectations change overnight,” says Dr Pallavi Gajakosh. “While not all birth defects can be prevented, many can be reduced, anticipated or managed far better with timely and appropriate antenatal care.”

What can be prevented and the role of early care

A substantial proportion of birth defects are linked to preventable factors before and during pregnancy. One of the strongest examples is neural tube defects, which are closely associated with folic acid deficiency. Taking folic acid supplements before conception and during early pregnancy can dramatically lower this risk.

Other contributors include poorly controlled diabetes and thyroid disorders, infections such as rubella, alcohol and tobacco exposure, certain medications, and severe nutritional deficiencies. According to Dr Gajakosh, common clinical lapses include self-medication, discontinuing supplements due to nausea, assuming herbal remedies are always safe and skipping antenatal visits because the pregnancy feels uncomplicated.

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Modern antenatal care has shifted focus to the first trimester, often referred to as the “inverted pyramid” of pregnancy care where early screening offers the greatest benefit. Blood tests can identify anaemia, infections and metabolic disorders, while biochemical and ultrasound screening can flag early risks of pregnancy-induced hypertension, gestational diabetes and fetal growth restriction. Timely vaccinations and nutritional counselling further support healthy fetal development.

Prevention begins even before pregnancy

Dr Prachi Benara stresses that the conversation around birth defects must start before conception. “Many congenital conditions are shaped much earlier than people realise, sometimes even before pregnancy begins,” she says.

Evidence shows that taking 400 micrograms of folic acid daily before conception and during early pregnancy can reduce neural tube defects such as spina bifida by up to 70 per cent. Women with diabetes, obesity or a history of affected pregnancies may need higher doses under medical supervision. Stabilising chronic conditions like diabetes or thyroid disease before conception is equally critical, as poor control has been linked to higher risks of congenital anomalies.

Once pregnancy begins, structured antenatal care becomes essential. The World Health Organisation recommends at least eight antenatal visits starting in the first trimester. “These visits are not routine box-ticking exercises,” Dr Benara notes. “They allow risk assessment, nutritional guidance and screening for chromosomal and structural abnormalities.”

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What can be detected early and why it matters

While not all birth defects are preventable, many can be detected early through routine screening. Targeted ultrasound scans can identify abnormalities of the heart, brain, spine, kidneys and limbs, while advanced screening tests assess chromosomal risks.

Dr Gajakosh explains that early detection is about preparedness rather than panic. “It gives parents time to understand the condition, plan delivery at an appropriate centre and, in some cases, initiate treatment soon after birth or even before,” she says. “Equally essential, it allows families to process information and make informed decisions with medical guidance.”

Awareness, lifestyle and informed choices

Dr Vadana Mittal points out that January, observed as National Birth Defects Prevention Month, is a reminder of how preventable many congenital conditions can be. Worldwide, nearly eight million birth defects occur every year, and in India, the risk remains around six to seven per cent.

“The most critical window for development often closes before a woman realises she is pregnant,” Dr Mittal says. “Periconceptional folic acid supplementation alone can prevent up to 70 per cent of neural tube defects, yet remains underutilised.”

Beyond nutrition, eliminating exposure to tobacco, alcohol and harmful substances is crucial. Regular antenatal screenings, timely vaccinations and genetic counselling for families with inherited conditions add further layers of protection. “Good maternal health is not a reaction to pregnancy,” Dr Mittal says. “It is a foundation laid well in advance.”

A shared responsibility

Experts agree that reducing the burden of birth defects depends on closing the gap between medical knowledge and real-world practice. Antenatal care remains the single most effective tool to prevent avoidable defects, detect others early and ensure every child has the healthiest possible start.

“In medicine, hope lies in knowledge and preparation,” says Dr Gajakosh. “Antenatal care is not optional — it is essential.”

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Dr Tripti Raheja, Director – Obstetrics & Gynaecology at CK Birla Hospital (Delhi) says birth defects, also known as congenital anomalies, affect millions of newborns globally each year, but adds that many are either preventable or can be detected early with appropriate antenatal care.

“While genetic birth defects cannot be prevented, several congenital conditions can be reduced through early identification and elimination of modifiable risk factors,” she explains. One of the most effective preventive measures, she notes, is ensuring adequate folic acid intake before conception and during early pregnancy, which significantly lowers the risk of neural tube defects such as spina bifida.

Dr Raheja also highlights the role of uncontrolled maternal medical conditions. “Diabetes, thyroid disorders and epilepsy can increase the risk of congenital anomalies if not stabilised before and during pregnancy,” she says. In addition, infections such as rubella, toxoplasmosis and syphilis pose a serious threat to fetal development but are largely preventable through timely vaccination, hygiene practices and regular medical follow-ups.

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She emphasises that although not all birth defects can be avoided, many can be identified through modern prenatal screening. “First-trimester combined screening, anomaly scans and blood tests aid detect chromosomal conditions like Down syndrome, as well as structural abnormalities involving the heart, brain and skeletal system,” Dr Raheja says. Early diagnosis, she adds, allows families to plan deliveries at specialised centres and, in some cases, begin treatment even before birth.

According to Dr Raheja, antenatal care is not only essential for monitoring fetal development but also plays a crucial role in safeguarding maternal health. “Antenatal visits provide an opportunity to educate expectant mothers about nutrition, healthy lifestyle choices, vaccinations and disease prevention,” she says.

“While not every birth defect can be prevented, early pregnancy registration, regular follow-ups and strict adherence to medical advice remain among the most powerful tools we have to ensure a healthier pregnancy and a better start to life for every child,” she adds.

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