THE rate of birth defects has skyrocketed in two provinces in the last 15 years and risen across the entire country in that same period.Babies in the Caribbean coastal province of Limón have been hardest hit, registering nine times the number of defects from 2000-2004 as were reported in 1990-1994. Now the province has the highest rate in the country at 27 babies born with defects per 1,000, up from three per 1,000 in the first half of the last decade.Cartago, the Central Valley province east of San José, registers the second highest ascent with three times the rate that plagued it 15 years ago and the second highest rate in the country behind Limón. It registers 26 babies per 1,000 born with defects, compared to nine per 1,000 in the early 1990s.The figures are based on a comprehensive study by the Costa Rican Institute of Research and Education in Nutrition and Health (INCIENSA) this year. Their research was based on statistics from every maternity ward in the country since 1987. It is a population-based survey that accounts for more than 90% of the births nationwide.The registry became part of the worldwide network of birth defect analysis, the International Clearing House for Birth Defects Monitoring Systems (available on the Web at www.icbd.org), in 2002 after complying with its standards.When the numbers are broken down by cantons within the provinces, four have particularly high defect rates – Pocosí and Guacimo, in Limón, and Turrialba and Jiménez, in Cartago. The four are clustered together in an inland region of farmlands, registering 25 to 48 babies with defects per 1,000 born. By comparison, the canton Limón, which encompasses the port city and capital of the province of the same name, has little agricultural activity and registers only 15 babies with defects per 1,000 babies born.THOSE results point fingers at agricultural chemicals as a possible cause, but the case is not cut and dry and other factors are under consideration. Adriana Benavides, pediatrician and head of the INCIENSA project, said the institute is laying the groundwork for a five-year study of the defect rates and their causes in each region.“If the study discovers that something as important as agrochemicals are the cause, the government will have to go to the businesses and tell them not to use them, which will cause a big disturbance,” so researchers will take their time and inspect the problem from every angle, she told The Tico Times.Other causes Benavides is considering are malnutrition and poor access to health services, which she suspects could be a factor in the southern Caribbean canton of Talamanca, water quality, and an isolated gene pool. The latter, she said, is a problem in Cartago, where a few families have intermarried for generations, concentrating their genetic defects.The age at which a woman conceives her child is also a factor. Babies born to Costa Rican women under 20 years old have a slightly higher rate of defects – 19 per 1,000 – and those born to women 35 years old and older have a considerably higher rate – 27 per 1,000 – compared to 18 per 1,000 among women ages 20-34.INACCURACIES in the study could play some role in the dramatic results, Benavides said. When the country first began amassing such data in 1987, it was under a state decree that obligated doctors to report the deformed babies they delivered. But, Benavides said, “you know that for the Tico to obey a law, a few years have to go by,” so the quality of the information improved as doctors became accustomed to reporting.The results “could be a little magnified, but since 1996 they have been for at least 90% of the population, so these are real numbers,” Benavides said.The rate could be reduced by abouthalf with proper prevention measures,according to Lila Umaña, general directorof INCIENSA. One measure she recommendsis the consumption of a diet rich infolic acid, which helps the baby’s neuraltube form, an event that occurs in the firstmonth of pregnancy.THOUGH the defects rate has risen in every province since the early 1990s, Heredia, the Central Valley province north of San José, is the only one that can claim a decrease in the past 10 years. It began the 1990s with the second highest rate of defects, 17 per 1,000, and rose to assume the dubious distinction of the most defect-stricken province in the country in 1995-1999 with 23 per 1,000. Now, it is the only province of the nation’s seven to register a decline at any point in the 15-year period, having reduced its rate to 22 per 1,000 births. San José has maintained its rate of defects at about 19 per 1,000 births since the early 1990s. At that time it had the highest rate in the country; now it has the fourth highest.The northern Pacific province of Guanacaste has the lowest rate with nine deformations per 1,000 births, up from 4.5 in the early 1990s.SOME of the most prevalent and severe defects in the country are Downs Syndrome, which occurred among 56 babies born in 2002 (the earliest available statistic); malformed or missing limbs, which occurred among 33 babies in 2002; spina bifida, in which the backbone and spinal cord do not close and the spinal cord can protrude from the newborn’s back, a condition that occurred in 20 Costa Rican babies in 2002; and ancephaly, in which the baby is born without some or all of its skull and the brain is missing or not completely formed, a defect that occurred in 10 Costa Rican babies in 2002.Costa Rican law prohibits abortion to terminate pregnancies with known defects. Defects are the second leading cause of infant mortality in Costa Rica, accounting for 40% of deaths. Infant mortality has dropped, however. Since 1979 the rate of infant death has dropped by over half, from 22.12 per 1,000 infants then to 10.10 per 1,000 now, the National Statistics and Census Institute (INEC) reports (TT, March 11). Spina bifida is also on the decline, having dropped by 31.5% since 1999 thanks to the addition of vitamins and folic acid to the food women of reproductive age eat (TT, Feb. 11).Besides birth defects, INCIENSA studies diabetes, cardiovascular disease, obesity and other conditions, and conducts specialized laboratory studies of epidemic diseases such as dengue, rubella, tuberculosis, leptospirosis, Chagas and others.
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