Prevent Spina Bifida by Planned Pregnancy

File:Meningomyelocele diagram.jpg

What is spina bifida?

Spina bifida is a congenital developmental disorder due to incomplete closure of embryonic neural tube, i.e. it is neural tube defect. In general term, spina bifida is a developmental defect (during development of fetus in mother’s womb), where some vertebrae (plural of vertebra) are not formed fully and the spinal cord remain exposed (remain unfused and open) in the area. If the opening in vertebral column is large, portion of spinal cord may protrude through the opening. Spina Bifida is a common congenital disorder occurring in 1 in 1000 live births.

Most common location of spina bifida is lumber (most common) and sacral areas of spinal/vertebral column.

There are various types of spina bifida, such as spina bifida occulta, spina bifida cystica with meningocele, and spina bifida cystica with myelomeningocele.

Causes and risk factors of spina bifida:

What exactly cause spina bifida is not known. The likely cause in multifactorial with environmental and genetic factors playing causative roles. Folic acid deficiency (during immediate preconception period and early pregnancy) is one of the known causes of spina bifida. Other causes and risk factors of spina bifida includes, race (more common in whites and Hispanics), family history, certain medications (anti epileptic medication valproic acid), diabetes, obesity and long duration of fever during pregnancy (during first trimester of pregnancy when the organogenesis or development of various organs in fetus takes place).

How to prevent spina bifida?

Among the causes and risk factors of spina bifida, there are some modifiable and non-modifiable risk factors. Preventive measures aim at the modifiable risk factors. Folic acid consumption/supplementation from one moth prior to pregnancy and in the first trimester (first 3 months of pregnancy) can reduce incidence of spina bifida by 70%, as shown in several studies. It is important to start folic acid supplementation prior to conception and continue till first 3 months of pregnancy. Because organogenesis occurs during 16th day of conception to 55th day. It is important to cover this entire period with folic acid supplementation.

Folic acid supplementation after diagnosis of pregnancy may not prevent spina bifida and other neural tube defects, because by the time pregnancy is diagnosed the organogenesis may have already started.

Alternately, foods rich in folic acid can be consumed during preconception time and during pregnancy. Foods rich in folic acid include spinach and other green leafy vegetables, fresh fruits, whole grains, sprouting beans etc. Foods fortified with folic acid are also good sources.

Panning of pregnancy can reduce risk and incidence of spina bifida. If you plan pregnancy, folic acid supplementation can be given at right time, obesity and diabetes (modifiable risk factors) can be controlled.

Minimum of 400 microgram of folic acid supplementation should be given daily. Folic acid tablets are available as 5 mg (5000 microgram). Excess intake does no harm and can be taken without any risk.

 

Image source: http://healthyone.org/wp-content/uploads/2013/06/FileMeningomyelocele_diagram.jpg

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