In pregnancy, then infancy, there are moments when certain factors -- nutrients, hormones, toxins -- can have a profound impact. Consider folic acid. If every woman of childbearing age had adequate amounts of this vitamin in her body, the incidence of neural tube defects, including spina bifida, would decline by 70 percent. Current efforts -- primarily fortification of flour with folic acid, which began in 1998 -- have already led to a 20 percent drop. While it's possible to get enough folic acid from diet alone, experts advise that every woman of childbearing age take a daily supplement of 400 micrograms.
But don't wait until you're pregnant. Folic acid needs to be present at the moment when an embryo's cells curve over one another to create the neural tube, between the 25th and 28th day after conception -- often before a woman knows she's expecting. A day late may be a lifetime short. "If the tube can't close, it can damage the entire central nervous system," says Mark Merkens, M.D., director of the Spina Bifida Program at Oregon Health Sciences University, in Portland.
That a simple pill could prevent most cases of spina bifida is remarkable. That the first recommendation for women to take folic acid came in 1992 shows how new the science is. What might we discover next?
A Delicate Beginning
Maybe we'll learn why women in the first trimester are often nauseated. We do know that can be a good thing: Those who experience the worst pregnancy sickness are at the lowest risk of miscarriage, stillbirth, or premature delivery. It's not clear why, although the queasiness may have evolved to keep women away from noxious foods that posed a threat to the fetus at a vulnerable time.
And vulnerable it is. First the spinal cord forms; then, in a matter of days, each organ appears. Within weeks, the embryo is a fetus, the length of a paper clip, with no further assembly required -- it simply grows bigger until birth. Writer Sandra Steingraber, Ph.D., in Having Faith: An Ecologist's Journey to Motherhood, describes the process: "Sometimes it seems like a magic show. At other times it's like origami, the formation of elegant structures from the folding of flat sheets."
Now's the time to heed those restrictive warnings: no smoking, alcohol, or drugs; no prescription, over-the-counter, or herbal medications unless specifically allowed. It's best not to:
- Paint the nursery (solvents; in an old house, lead)
- Use pesticides at home or in the garden
- Change your cat's litter (toxoplasmosis, from cat feces)
- Eat soft cheeses or deli meats (listeria -- food poisoning).
Above all, be vigilant about protecting yourself from infections, such as the flulike cytomegalovirus, or sexually transmitted diseases. "It's important to work closely with your obstetrician," says Donald Mattison, M.D., former medical director of the March of Dimes. "Call up, for example, even if you have only a slight fever."
What other critical moments might those nine months hold? Could a woman's healthy pregnancy open the window to her child's smarts or emotional equilibrium or the prevention of disease?