Benton, Franklin counties see more cases of fatal birth defect

Five more cases of anencephaly, a fatal birth defect, have been confirmed in Benton, Franklin and Yakima counties so far this year as the State Department of Health works to discover why the three counties have more cases than usual in the state and nation.

That brings the number of cases discovered from 2010 through this spring to 41. The number is four to five times higher than the national rate.

“Unfortunately, we don’t see any big smoking guns,” said Dr. Kathy Lofy, the state health officer.

Investigators continue to interview mothers of babies with the condition, and their answers are being analyzed to find any common factors.

The state also is proceeding with education campaigns to promote adequate folic acid intake for women who could become pregnant. Too little folic acid is a potential cause of the birth defect.

Anencephaly occurs in the first month of pregnancy. The brain and skull do not fully form, and the baby might die during pregnancy or soon after giving birth.

“Any loss of life at childbirth for the family is a tragedy,” said Andre Fresco, administrator of the Yakima Health District at a Walla Walla meeting of the Washington State Board of Health last week. “This has become a community tragedy.”

The sadness at the loss of life is compounded by the fear of the unknown and that more babies could be lost, he said.

From 2011 through 2014, the rate of anencephaly cases per 10,000 births has been 12.6 in Benton County, 9 in Franklin county and 6.7 in Yakima County. The national rate is 2.1 per 10,000 births.

The Washington State Department of Health has searched out cases, which could increase the rate of known cases per live births. But when data is considered that is collected in the same way statewide, it shows that the rate of anencephaly is more than double in the three counties than in the rest of the state.

The rates in the three counties are about the same for Hispanic and non-Hispanic white births, even though Hispanic ethnicity is known to increase the risk of neural tube defects such as anencephaly, Lofy said.

Other known risks are low folic acid intake, maternal diabetes, obesity and some medications.

A possible link between anencephaly and elevated nitrates in drinking water from agricultural activity is unclear. A look at affected pregnancies in 2013 found that three-quarters of the mothers were on large public water systems with nitrate levels that are considered to be safe.

Women drinking water from private wells are advised to have their water tested annually for nitrates and bacteria.

Chemical or radioactive contamination from the Hanford nuclear reservation is not considered a likely cause of the cases, according to the state. Most of the leaks into soil or water are contained at Hanford.

“It is highly unlikely that contamination from these leaks can get into the drinking water used by most of the women with affected pregnancies since they live throughout the three-county region,” state officials said in a letter this month to the Washington Democrats. State Democrats had called for more investigation of the cause of the birth defect.

Investigators originally identified 25 mothers of babies who had died from the condition, but were able to interview just 13 of them. Some could not be found and others declined to participate.

An additional five mothers more recently identified are being contacted for interviews.

Despite low response rates for the interviews, the state is hoping to learn more about possible common exposures that have been suggested, such as nitrates in drinking water, parents who work in the agricultural industry, living close to agricultural fields and household pesticide use.

The Centers for Disease Control and Prevention is analyzing answers to questions asked about what the women eat.

Women ages 15 to 44 are urged to take 400 micrograms of folic acid daily, starting before they become pregnant because the birth defect can occur before they learn they are expecting. They also should see a doctor or other health care provider before they get pregnant, and then keep all appointments through their pregnancy, according to the state.

Bread, cereal and other foods made with fortified flour in the United States are required to include folic acid to guard against birth defects.

However, women on reduced or gluten-free diets can miss out on folic acid, said Dr. Diana Yu, of the Washington State Board of Health.

People who eat traditional Latin American food also might get smaller amounts from fortified food because corn masa, used to make tortillas and tamales, is not covered by requirements. The federal government is considering expanding fortification to corn masa.

The Washington State Department of Health has started an information campaign to spread the word on the importance of folic acid, a B vitamin, as it continues to investigate the cause of the high number of anencephaly cases.

This month it started airing 30-second messages developed by the March of Dimes on English- and Spanish-language radio stations in Benton, Franklin and Yakima counties.

In addition, it is airing a Spanish-language radio novella that follows a young Latina woman through 12 episodes. Each story focuses on a different aspect of preconception health, including the importance of folic acid.

Printed material on folic acid also is being distributed by the state.

However, board members said that the Department of Health said additional money would be needed to sustain that information campaign over years to keep reaching young women.

This story was originally published June 20, 2015 at 6:56 PM with the headline "Benton, Franklin counties see more cases of fatal birth defect."