About half of pregnancies are not planned, but it is in the preconception and earliest days of pregnancy that most birth defects can be impacted.
That's why a slew of agencies, both government and private, say the best way to see that babies are born healthy is to improve the health and overall well-being of all women of child-bearing age.
That message was delivered Wednesday during the March of Dimes Prematurity Summit, held at the University of Utah. Dr. Uma Reddy, head of the Pregnancy and Perinatology Branch at the National Institute of Child Health and Human Development, was the keynote speaker.
She said poor pregnancy outcomes still occur at "unacceptable levels" nationwide and that many women are "at risk" for adverse outcomes even as they enter pregnancy, while many of the interventions offered come too late.
What's needed, she said, is to tackle the risks and change what we can that could be harmful to a pregnancy such as seeing that women have enough folic acid to prevent neurological defects before conception even occurs.
Reddy based her presentation on slides created by Dr. Hani J. Atrash, associate director for program development at the National Center on Birth Defects and Developmental Disabilities and a Centers for Disease Control and Prevention work group on preconception care.
In Utah, 974 babies are born in an average week, 106 of them preterm, 65 with low birth weight. Five of them die before their first birthday, and one in four has a birth defect. One-fourth of Utah births are by C-section, as well, and 2.7 percent are multiple births (twins, triplets, etc.)
In the United States, about 3.3 percent of babies born have major defects, Reddy said. And nearly one-third have some kind of complications of pregnancy, while a comparable number need a C-section. One in 12 babies is born with low birth weight, which can lead to a number of complications and problems. And one in eight is born prematurely.
Where for decades, maternal mortality rates were decreasing, they now seem to be inching up slightly. And babies born with very low birth weight have increased dramatically since the 1980s, while premature births are also on the rise.
The decline in infant mortality goes on, but the rate "continues to be very high," said Reddy. And complications of pregnancy are No. 3 as a cause of infant deaths.
Among behaviors experts want dealt with prior to pregnancy are smoking, alcohol consumption, pre-existing medical conditions, obesity and oral disease, among others. They are promoting the idea of "preconception" counseling and health assessment that includes warnings about risk factors that can lead to birth defects or the untimely end of a pregnancy, including drugs that are known to cause birth defects.Getting prenatal care early is important, she said, but it is "not enough, and in many cases, it is too late."