If a woman didn't miscarry, she had to make a decision whether to terminate her pregnancy or go ahea...

1. Mysterious cluster of birth defects stumps doctors
If a woman didn't miscarry, she had to make a decision whether to terminate her pregnancy or go
ahead and have a baby sure to die soon after birth. Her daughter, Olivia, was born in September
with spina bifida, which, like anencephaly, is a neural tube defect the state is also tracking. That
doctor had just seen a case of anencephaly, too. Unlike anencephaly, however, spina bifida is usually
not fatal.
She says she's incredulous and outraged that state researchers haven't called to ask questions: What
did she eat while she was pregnant? Did she spend time near farms that sprayed pesticides? Did she
take any herbs or supplements? How about Olivia's father? Was he exposed to any toxic chemicals?
But no one has called.
Barron's phone call spurred epidemiologists into action. "I wish they would take it more seriously."
.
"From a research point of view, this is very bad research," she says.
She says medical records reveal whether a woman has been prescribed any drugs, or diagnosed with
a certain condition, but they don't contain detailed information about a mother's diet or possible
toxins she might have been exposed to in the environment.

2. Even the state Department of Health admits that medical records are limited, writing in a press
release: "Medical record reviews might not have captured all information, preventing a cause from
being identified."
But doing the research the right way, Ritz says, costs hundreds of thousands, if not millions, of
dollars, and state health departments often don't have those funds. She called the state Department
of Health and made a report.
While pregnant, Jackman lived in the Yakima Valley, an agricultural area in south-central
Washington.
Barron mentioned the unusual spike to an obstetrician friend working at another hospital 30 miles
away. "We have to weigh how invasive we want to be with these types of interviews."
Jackman says that attitude is paternalistic and condescending. I think there's absolutely something
going on that needs to be investigated more thoroughly," she says.
That's it, Barron thought to herself.

3. By the address, epidemiologists can learn a mother's water source, whether she lives near an
agricultural area and whether she took folic acid early in pregnancy, which helps prevent neural
tube defects. They went through hospital and doctors' records in a three-county area and found 23
cases of anencephaly from zofran birth defects lawsuits January 2010 to January 2013.
'I wish they would take it more seriously'
In a few months, Washington state's Department of Health plans to report how many babies were
born with neural tube defects in 2013 to see if the cluster has continued, Stahre says, adding that it
may interview the mothers at some point in the future.
"We're still investigating this," she says. This is a devastating diagnosis, and we know that for a lot of
these women they had to make some hard choices," Stahre says.
"I think it's very scary. "This is nowhere near finished."
In the meantime, she says pregnant women in the area should not be nervous.
But Barron, the nurse who found the original cases of birth defects, isn't so sure.
'What are you researching?'
For months, Andrea Jackman has been expecting a call from the Department of Health.
"The data quality on medical records is so low that it's not really research," she says.
"(Medical records) give us a lot of information about all of the known risk factors," the
epidemiologist says.
"What are you researching if you haven't physically called the families to find out?" she asks.
Stahre and her colleagues asked themselves: Would a phone call traumatize these women?
"We have to weigh that heavily.
The http://www.everydayhealth.com/drugs/ondansetron state's rigorous search of the women's
medical records, along with birth and death certificates, found nothing linking the families who had
babies with birth defects.
Ritz, vice chair of the epidemiology department at the UCLA Fielding School of Public Health, says
medical records are notoriously unreliable: One doctor, for example, might note whether a woman
smokes, but another doctor might not.
To see that many in such a small hospital seemed bizarre to her. Beate Ritz, who's done several
studies on birth defects. State epidemiologists should have made those phone calls a long time ago,
she says, since every day that passes, her memory, and those of other mothers, start to fade about
what their habits were during pregnancy. Such a finding meant a rate of 8.4 cases per 10,000 live
births -- four times higher than the national average of 2.1 cases per 10,000 live births.
'Very bad research'

4. Stahre has an answer to Jackman's question: The state examined the mothers' medical records,
which revealed, among other things, the women's home addresses. She says she would do anything
to help prevent another family from having a baby with a severe birth defect.
But the next part of the investigation has come under fire with accusations that state
epidemiologists haven't looked hard enough for the cause of a birth defect that's always fatal. Most
of the women were pregnant with babies who had anencephaly, and the outcome is always horrible.
That finding doesn't surprise Dr.
Mandy Stahre, the state epidemiologist who's investigating the cluster of birth defects, says it might
be upsetting for mothers to get a call with such questions. Story highlightsBirth defects in three
counties are four times more than national averageOne of those children in Washington state is
Olivia Jackman, born with spina bifidaState investigators say they're still investigating the cluster of
birth defectsSome question whether they've done enough to find a causeIn her 30-year career as a
nurse, Sara Barron had seen only two babies with anencephaly, a tragic birth defect in which infants
are born missing parts of their brain and skull.
Then in 2012, while working at a hospital in rural Washington state, she saw two cases in two
months