The cause of birth defects, unfortunately for the majority, so anywhere from 70%-80% of birth defects, we do not know the cause. Most likely it's an environmental or genetic or gene environment interaction and that's where research is very important to really try to understand the underlying cause. Is there something in the environment that is modifiable? Can you modify the exposure in the population to reduce a woman's risk for a birth defect? For example, we know that smoking increases the risk for oral facial cleft, so cleft lip with palette. If we can get women to stop smoking prior to pregnancy, before they conceive, then her risk will be reduced for that particular birth defect. We're really working nationally as well as internationally to try to figure out what those modifiable environmental factors are so that you can develop primary prevention educational campaigns within a population to educate women to change their behavior before getting pregnant. It's the before getting pregnant that's very important, not once you find out you're pregnant. Because the organ systems that develop early in pregnancy are developing between two to eight weeks after conception and oftentimes women will not even recognize that they're pregnant until many weeks into the first trimester. So the brain, the spinal cord, the heart, and that's almost completed by eight weeks. There are some things that continue to develop but the embryo, that two to eight week period is the critical time period of development. So for example, spina bifida, that's an abnormality of the neural tube, it doesn't close correctly. That actually is occurring between 14-30 days after conception, very early. Women do not even recognize that they're pregnant at that time. If they're smoking or drinking alcohol and they don't know that they're pregnant, they're exposing that developing embryo early in pregnancy. So that's why it's so critical to actually make sure that behaviors are stopped if they're a risky behavior prior to pregnancy, prior to that conception date.

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