Birth Defects and Prevention

Michelle Reese, Chief Programs Officer at the Healthy Start Coalition of Miami-Dade, discusses birth defects and prevention.

Michelle Reese serves as the Chief Programs Officer for the Healthy Start Coalition of Miami-Dade (HSCMD), a community-based, non-profit organization designated and funded by the State of Florida Department of Health (FDOH) and the Agency for Health Care Administration (AHCA) to serve as Miami-Dade County’s prenatal and infant care coalition. In her role, Ms. Reese oversees the Coalitions programs and related services. Her primary responsibility is to develop and lead HSCMD’s programs team in the execution of the Coalition’s mission and vision.  As an executive leader, Ms. Reese brings 17 years of professional experience in managing operations, programs and projects. She has been a member of various professional and community involvement organizations and has served on numerous advisory committees and governing boards. Ms. Reese earned a Bachelor of Science in social work with a minor in psychology from Florida International University.


Neal Howard: Hello and welcome to Health Professional Radio. I’m your host Neal Howard, glad that you could join us. Our guest is Michelle Reese, Chief  Programs Officer at the Healthy Start Coalition of Miami-Dade and she’s joining us here on Health Professional Radio today to talk about birth defects and birth defect prevention. Welcome to the program Michelle, how are you?

Michelle Reese: Hi! Good, thank you. Thank you so much for having me.

Neal: Well I’m glad that you could take the time to talk with our listeners. Give our listeners a bit of background about yourself. You are Chief Programs Officer at the Healthy Start Coalition, but what is a bit of your background? Are you a healthcare professional?

Michelle: Yeah, sure. I’m actually a social worker by trade but for the last 17 years have been in management and in executive leadership. For the previous ten years, I actually ran a not-for-profit coalition dedicated to improving maternal, infant, child health in Broward County and most recently joined the Miami-Dade County Healthy Start Coalition as the Chief Programs Officer. So basically executive leadership, project management, program management of specific programs dedicated to improving the lives of women, children and families – really focusing on reducing infant mortality and women’s health as a whole is where my experience has been for the last 17 to 20 years.

Neal: Now you’ve been involved for a lot of years in birth defects, getting awareness out, prevention information. An obvious question surely but maybe not, what constitutes a birth defect? We’ve been hearing about birth defects our entire lives, but is it true that some “defects” aren’t deemed as important or as severe or as intense as others?

MIchelle: Well I think you have a couple of different types, if you say, categories of birth defects. Some are major structural or others are genetic birth defects. Locally here in Miami-Dade County, we have about 1 in 22 infants, because right now we have 32,000 live births happening in Miami-Dade County alone. Ironically, one in 22 are actually born with some type of birth defect and right now birth defects as a whole are the leading cause of infant deaths in Florida and the United States actually spends billions on hospitalization costs for those birth defects. The thing with birth defects is it’s caused by an array of things so you have things that very specifically contribute to a birth defect occurring in a woman’s pregnancy and then you have those things that we would probably deem risk factors so those things that directly contribute to birth defects or are called birth defects. Some of them are unfortunately no fault of the mother, they can be caused by genetic problems, perhaps with chromosomes. There may be additional environmental factors and in that case, those are things that we would call are preventable. A  mother who potentially is using alcohol or substance use during pregnancy. I think one of the major contributors to birth defects is not having enough folic acid. We hear a lot about folic acid especially when a mom goes to her obstetrician and that’s the first thing they’re going to say is to “Take your prenatal vitamins. Make sure you’re getting enough folic acid.” And folic acid is basically in layman’s terms the vitamin of the B complex, so it’s found in a lot of our green leafy vegetables but it’s really important that the pregnant woman takes those during pregnancy. But one of the things that constitutes I think that to this situation as a whole is more than half of pregnancies are unplanned. And so the problem is a mother comes into pregnancy, is half of them, more than half of them are unplanned. Then what that means is that you have mothers that are unhealthy coming into pregnancy. If they didn’t plan it and they’re potentially still using alcohol or tobacco even, something that’s just cigarettes but cigarettes again during pregnancy can have a dramatic impact so that’s a big factor. In terms of what is constituting the problem of birth defects is women who are not having who are not seeking and planning to have a healthy pregnancy and they’re not on an ongoing basis getting primary care. And so when we talk about, just I think globally, we know that right now maternal health is impacting poor birth outcomes. And a lot of moms who are having poor outcomes, it is associated with chronic conditions – diabetes, you have hypertension. Those types of things that are happening in a mom’s primary healthcare that are not getting addressed before they got pregnant. So that is a big factor in terms of what’s causing risk factors separate and apart from that I think you have a number of … are considered risk factors that unfortunately make it much higher for a mom to potentially have a birth defect. Ironically particularly here in Miami-Dade County, if a mother is born, the mother of Hispanic ethnicity actually, it is a risk factor for neural tube defects. So that’s something that a physician has to monitor just because unfortunately and I think that’s one risk factor but our controlled risk factor is weight, so I think we all across the country, we see how obesity rates had climbed and that’s not specific to pregnant moms, that’s I think globally. But for an obese mom, that actually gives them a much higher chance of potentially having a baby born with some type of a defect. I think another factor is women who are age 35 and older, I mean it is kind of most women today are waiting to have children and that’s not uncommon but in the world of pregnancy, a mother who’s 35 years and greater it’s actually considered advanced maternal age so with that said, although we don’t want to admit that … but I don’t want to admit that but legitimately it is the contributing factor so when you look at just a number of Down Syndrome cases here in Miami-Dade where we’re at, there’s so such a significant number. Some of that is contributed to unfortunately, again advanced maternal age does play a role but it’s one risk factor of so many so I think it starts to paint a picture of kind of what’s happening when we’re talking about birth defects. I mean what can we do better as a community? I think one of the biggest things is really recognizing that we have to be healthy and  getting pregnant and having a baby really should be planned in order to ensure that that mom is really ready for a healthy pregnancy. They’re even six months before the pregnancy that can start those prenatal vitamins and preparing herself for that upcoming positive outcome.

Neal: When you’re talking about preparing for pregnancy, it seems to me based on what you’re saying that there’s so many risk factors – environmental, genetic, the fault of the mother based on what she’s doing. If you’re going to plan a pregnancy, maybe that planning should start in elementary school. I mean we’ve talked about condoms, we’ve talked about STDs our entire lives but as you said, in the outset of our conversation, more than half of pregnancies are unplanned. I’m thinking way more than half are unplanned because you go through your life and then you get married and “Oh you’re still smoking, you’re still doing whatever you do and now let’s have a baby.” So now you’re going to plan this but you’ve lived a lifestyle of 15-20 years or more that is very detrimental to having a baby.

Michelle: That is such an excellent point that you raise, something that in the world of maternal infant child’s health we refer to as the life course perspective and that is somewhat of a cumulative amount of life course experiences, your life experiences from conception until adulthood that play a role in terms of your poor potential poor pregnancy outcome. Social determinants of health that you’re talking about. For example, someone not having access to healthcare, someone not having access to transportation. How does food and security  potentially impact poor birth outcomes? How does potentially some of these low socioeconomic class, unfortunately race is a risk factor as well so when you start talking about what you said is spot on. In fact that is what we would refer to as preconception care, is the education that should be happening from the time, we begin at youth and in order to have a positive beyond a positive birth outcomes, to have a positive life outcome, the education does have to start as early as you described. What’s very interesting is so for so many years, we continue to see all of these elevated rates of all these potential maternal health factors and chronic health conditions contributing to our overall infant mortality rate and infant mortality is a measure of the health and well-being of a community. So if legitimately the social determinants, if we’re continuing to see poor outcomes, it is bigger than just what’s happening during pregnancy and right now across the state and nationwide even at the federal level, the priorities are actually focusing on the social determinants of health. We are now required to ensure that along with that important … education we’re talking about and some of those basic health education and ideas, we are required to ensure that we’re addressing these social determinants of health because we recognize that it is not just the health factors that are contributing – it is all those life experiences that have occurred and accumulated through that child’s life to adulthood that are actually impacting the overall outcome. And that’s a hard problem to tackle, that is not one agency, one program – that is a collective, collaborative effort as a community, working together to address unmet needs, health inequities which in some cases does include racism. That dealing with institutional things that are still contributing to women not playing in the same level playing field to just dealing with trauma that some of these families potentially have dealt with that are also impacting. Stress plays a huge role in terms of poor outcome, so it is very complex and so when you raise that issue, you are spot on with that,

Neal: Well where can our listeners go and get some more information online about the Healthy Start Coalition of Miami-Dade and about some of these factors that we’ve been talking about?

Michelle: Sure. Well our website and our phone number 305-541-0210. The State Florida Department of Health which is one of our funders has a lot of great information about some of this as well so you can also find important information on their website in addition to ours. And I know that again collaboratively together, we hopefully will continue to impact birth outcomes and make a difference.  

Neal: Well thank you for joining us here on the program today Michelle Reese, Chief Programs Officer at the Healthy Start Coalition of Miami-Dade.

Michelle: Thank you so much.

Neal: You’ve been listening to Health Professional Radio, I’m your host Neal Howard. Transcripts and audio of this program are available at and

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