**4. Prevention**

Excluding genetic counseling, the genetic disorder cannot be protected against; simple guidelines to pregnant mothers for prevention of CHD in their newborns are good diet, physical activity, lifestyle, environments and occupation that the parents should discuss with their primary care provider or obstetrician. Women of childbearing age also should obtain prenatal care, including testing for diabetes and past rubella immunization, they should also discuss any medication use with their obstetrician; and should avoid contact with ill people, especially those with rubella or influenza. Women of childbearing age should take 400 micrograms of folic acid on a daily basis starting before pregnancy, which can reduce congenital heart and neural tube defects, and should avoid certain types of behaviors such as exposure to organic solvents, smoking and heavy alcohol use. If a woman has no immunity to rubella, she should get vaccinated prior to pregnancy. Preconception care and appropriate dietary management for women with phenylketonuria should be an important strategy. Detection and appropriate management of diabetes before and during pregnancy should be an important step for reducing risk of CHD in offspring. Avoidance of medications that are suspected to cause congenital defects, including congenital heart disease, should be taken, and the medications should have warnings about that risk to allow mothers and physicians to make informed decisions about the risks and benefits of the use of the medication during pregnancy. Recommendations also are possible for screening for possible cardiac defects using fetal echocardiography during pregnancy when warranted by reports of prenatal maternal illnesses or exposures. The need for screening any individual should be made on an individual basis from the type, likelihood, and level of potential exposure, as well as the time of gestation during which it occurred. This decision typically will be made as a result of the obstetrical history. Because congenital heart defects represent some of the more prevalent birth defects, that result in significant lifelong morbidity, and are an important cause of mortality attributed to birth defects, the development of effective prevention interventions is paramount from a public health perspective.
