There’s a mystery involving rare birth defects in a small rural area of Washington state that’s pitting mothers and medical personnel against the state’s health department. The mothers and medics say the public officials are not doing enough to track down the source of these birth defects but the state officials say their wait-and-see approach is the best they can do. Money is part of the problem, too. In spite of the differences, everyone wants to know why these three counties are experiencing this bewildering cluster of birth defects.

The birth defects are neural tube defects called spina bifida and anencephaly. The neural tube is a hollow structure that forms in early fetal development; it will become the baby’s brain and spinal cord as the pregnancy develops. Spina bifida and anencephaly both develop during days 20 to 30 after fertilization. Women are urged to take folic acid before conception and throughout pregnancy to decrease the risk of neural tube defects.

Spina bifida ("split spine") occurs when the neural tube doesn’t close fully around the spinal cord, leaving the spinal cord and meninges (membrane surrounding the cord) exposed. Spina bifida isn’t always fatal but most children with it have or will develop lower body paralysis to some degree. Mental impairment can occur, too.

Anencephaly ("without a brain") is always fatal. An anencephalic child is born with part or all of its brain and/or skull missing. Most fetuses with this condition are stillborn and the remainder doesn’t survive more than a few days after birth.

Southeast Washington, where Sara Barron is a nurse, is agriculture country. During Barron’s 30-year nursing career, she saw only two cases of anencephaly but two cases in two months in 2012 left her mystified. She mentioned it to an obstetrician friend working 30 miles away. Barron’s friend remembered a recent anencephaly case, too.

Barron called the Washington Department of Health to report this cluster of cases. State epidemiologists reviewed hospital and doctor records for the three counties in Barron’s area and discovered 23 cases of anencephaly during 2010, 2011, and 2012. That’s 8.4 cases per 10,000 live births. The national average is just 2.1 cases per 10,000 live births. Anencephaly was occurring more than four times more often in these three Washington counties than anywhere else in the United States. Why?

Barron, her friend, and local mothers of children recently born with neural tube defects wonder why the state isn’t investigating this in depth. Could local agricultural pesticide use be the cause? Was it something the mothers ate or did? Medicine they took? The individuals aren’t part of the investigation but why not? They’re the very best source of information involving the details of their own pregnancies.

Instead, the state is working strictly from medical records and looks forward to analyzing birth records for 2013 to see if the trend continued. Their critics say medical records are too incomplete and inconsistent to be of use.

And then there’s the money. State officials say a house-to-house investigation of all families of babies born with neural tube defects would cost too much, perhaps millions of dollars and the state just can’t afford it.

Source: Cohen, Elizabeth. “Mysterious cluster of birth defects stumps doctors.” CNN Health. Cable News Network / Turner Broadcasting System, Inc. Mar 1, 2014. Web. Mar 7, 2014.