Health disparities and birth defects

What are birth defects?

Birth defects are physical or biochemical changes that are present at birth. They can affect almost any part of the body. They can cause problems with how the body develops or how the body works. These changes can be mild or serious.

Birth defects can be discovered at any time during pregnancy, but most are discovered during the first 3 months of pregnancy (also called first trimester), when your baby’s organs are forming. Birth defects also can happen later in pregnancy, when your baby’s organs are still growing and developing.

What causes birth defects?

We don’t know exactly what causes most birth defects, but some things may make you more likely than others to have a baby with a birth defect. These are called risk factors. Having a risk factor doesn’t mean for sure that your baby will be affected. But having one or more of the following risk factors may increase your chances of having a baby with a birth defect: 

• Changes in genes or chromosomes.  Some birth defects are caused by changes in a baby’s genes (also called mutations) or chromosomes. Genes are part of your body’s cells that store instructions for the way your body grows and works. Genes are passed from parents to children. Chromosomes are the structures that hold genes. Some birth defects also run in families.
• Things in your environment. Your environment is all the things you come in contact with that affect your everyday life. This includes where you live, where you work, the kinds of foods you eat and how you like to spend your time. Some things in your environment can be harmful to your baby during pregnancy, such as cigarette smoke or harmful chemicals.
• Having certain health conditions. Some health conditions, like preexisting diabetes, can increase your baby’s risk of having a birth defect.
• Taking certain medicines before or during pregnancy. Taking certain medicines, such as isotretinoin, can increase the risk of your baby having a birth defect. Isotretinoin is a medicine used to treat acne.
• Smoking, drinking alcohol or using street drugs during pregnancy. Doing any of these things during pregnancy can cause problems for your baby, including birth defects.
• Getting certain infections during pregnancy. If you become infected with certain viruses during pregnancy, your baby may have a higher risk of having a birth defect. Chickenpox is one example, but there are others, such as cytomegalovirus (CMV) and rubella.
• Age. If you are pregnant after the age of 34, you may be at increased risk of having a baby with a birth defect.

Overall, about one in 33 babies (about 3 percent) is born with a birth defect in the United States each year. In some groups of people, the risk of your baby having certain birth defects may be higher due to health disparities.

What are health disparities?

A health disparity is a difference between the health of one group of people compared with the health of another group that has more advantages. The causes of health disparities are complicated. Health differences may be linked to a disadvantage caused by your income, work status, or environment.

Health disparities can mean that certain groups of people:

• Have more trouble staying healthy
• Have more trouble getting health care services
• Are at higher risk for certain health problems
• Are at higher risk for dying from certain health problems

The main reasons for health disparities are:

• Implicit bias. Biases are incorrect or oversimplified ideas that affect our understanding, actions, and decisions. Implicit means that we may not be fully aware of our biases.
• Systemic racism (also called structural racism). This is a system that gives one group of people an advantage while giving another group a disadvantage based on race, color, ethnicity, and culture. Systemic racism causes many inequities, such as unequal access to quality health care.

March of Dimes is concerned with the impact that health disparities have on the health and well-being of babies, families and the U.S. population. March of Dimes supports research, programs and policies that aim to reduce health disparities and ensure that all pregnancies and babies are healthy.

Do birth defects affect some groups more than others?

Some racial and ethnic groups are affected more by certain types of birth defects. According to a large study that reviewed records of 13.5 million births in the U.S.:

• American Indian/Alaska Native people have a significantly higher rate of having a baby affected by cleft lip with or without cleft palate, compared with non-Hispanic white people
• Compared with non-Hispanic white and non-Hispanic Black women, Hispanic women have the highest rate of having a child affected by spina bifida

Babies in certain racial groups are more likely to die from causes related to birth defects. A report by the Centers for Disease Control and Prevention (CDC) found that infant deaths related to birth defects were:

• 34 percent higher for babies of non-Hispanic black mothers than for babies of non-Hispanic white mothers
• 26 percent higher for babies of Hispanic mothers than for babies of white mothers

There are many reasons for these disparities. Access to and use of health care services before and during pregnancy is one reason.  More research is needed to understand the other reasons. For example, in one study, babies born to Black mothers were 40 percent more likely to die from congenital heart defects than babies born to white mothers. The researchers have suggested that social determinants of health, such neighborhood poverty, may be a factor.

The United States has a long history of unequal treatment in health care for people of color and provider implicit bias. These two factors can have a major impact on the health outcomes. March of Dimes is working to engage in health system reform, including re-educating providers about implicit racial bias, to ensure that all families and babies have a fighting chance.

Why is the risk of birth defects higher for certain groups?

Things that increase the risk of having a baby with a birth defect are called risk factors. Some examples of risk factors include using harmful substances and having a fever during early pregnancy. But other things, such as social factors, may play a role too. For example:

Access to preconception and prenatal care

Prenatal care is medical care you get during pregnancy. With early and regular prenatal care, your provider can help you prevent and manage many of the things that increase the risk for birth defects. But not everyone gets enough high-quality prenatal care. About 25 percent of women (1 in 4 women) in the U.S. do not get the recommended number of prenatal visits. Among African American women, about 32 percent, or 1 in 3, don’t get the recommended number of prenatal visits. Even more American Indian or Alaska Native women (about 41 percent, or about 4 in 10) do not get the recommended number of prenatal visits.

Being at a healthy weight makes a difference

Some health conditions, like being overweight or having obesity, can increase your baby’s risk of having a birth defect. Having access to healthy foods and a safe environment to help you stay physically active is important to keep a healthy weight, but not everyone lives in a community where this is available. Data show that people from racial and ethnic minority groups, those who live in low-income communities and groups in rural areas, are impacted most by this limited access.

Pollution and environmental exposures

Your environment is all the things you come in contact with that affect your everyday life. This includes where you live, where you work, the kinds of foods you eat and how you like to spend your time. Some things in your environment can be harmful to your baby during pregnancy, like cigarette smoke or harmful chemicals. Researchers are still learning about the causes of birth defects, including the role environmental exposures play.

A recent report from the Environmental Protection Agency (EPA) found that Black people in the U.S. are exposed to higher levels of air pollution regardless of their income levels. This type of exposure can lead to serious long-term chronic health issues. Based on what we know, chronic health conditions can increase the risk of having a baby with a birth defect, when not controlled.

Having access to health care

Having access to regular and quality health care at all stages of life is important. It helps promote healthy behaviors, improves management of different types of chronic health conditions, allows for fewer health disparities, and overall leads to better health outcomes. Unfortunately, some racial and ethnic groups in the U.S. are less likely to have access to health care, which increases their risk of poor health outcomes and complications.  

While we can’t be certain that these factors cause birth defects, a relationship may exist. More research is needed to understand how these factors are related to birth defects.

Can you reduce the risk of your baby having a birth defect?

Even if you are in a group of people that is affected by health disparities, there are things you can do to help reduce the risk of your baby having a birth defect and increase the chances of having a healthy baby. If you don’t have access to regular health care, you can contact your local health department about health care services in your area.

Other things you can do include:

• Getting a preconception checkup.
• Take folic acid. 
• Get early and regular prenatal care. 
• Learn about your genes and your family health history.
• Get to a healthy weight. 
• Don’t smoke, drink alcohol or use drugs that your health care provider doesn’t know about. 

Avoid harmful substances in your environment, such as:

• Strong chemicals, pesticides, lead, radiation or chemotherapy medicines  
• Avoid secondhand smoke during pregnancy
• Don’t eat fish that contain large amounts of mercury during pregnancy

Prevent infections, such as:

• Zika
• Toxoplasmosis
• Cytomegalovirus (also called CMV)  

Last Reviewed: June, 2021