Spina Bifida Prevention and Future Pregnancies

Prevention of neural tube defects

Because the neural tube closes 28 to 32 days after conception and before many women are aware they are pregnant, normal development of the brain and spinal cord may be affected during these first three to eight weeks of pregnancy by the following:

• Genetic problems
• Exposure to hazardous chemicals/substances
• Lack of proper vitamins and nutrients in the diet, especially folic acid
• Infection
• Prescription drug and alcohol consumption

Although there are many factors related to the development of spina bifida, research has found that folic acid (vitamin B-9), a nutrient found in some green, leafy vegetables, nuts, beans, citrus fruits, and fortified breakfast cereals, can help reduce the risk of neural tube defects. For this reason, the American College of Medical Genetics (ACMG) and the Centers for Disease Control and Prevention (CDC) recommend that all women of childbearing age take a multivitamin containing folic acid. If a couple has had a previous child with an open neural tube defects (ONTD), a larger amount of folic acid is recommended and can be prescribed by the woman’s physician or healthcare provider. This allows the woman to take it for one to two months prior to conception, and throughout the first trimester of pregnancy, to reduce the risk of another child with ONTD. Current research is focused on looking at how genes control the formation of the neural tube. Understanding this will assist in the prevention of neural tube defects.

Additional risk factors include:

• Maternal age: Spina bifida is more commonly seen in teenage mothers.
• History of miscarriage.
• Birth order: First-born infants are at higher risk.
• Socioeconomic status: Children born into lower socioeconomic families are at higher risk for developing spina bifida. It is thought that a poor diet, lacking essential vitamins and minerals, may be a contributing factor.

In recent years, pioneer surgeons have developed an experimental technique for performing surgery prenatally to correct this condition before birth. The surgery, used in a research setting and performed between weeks 19 and 25 of pregnancy, was first supported by the March of Dimes. Currently, the National Institute of Child Health and Human Development (NICHD), part of the National Institutes of Health (NIH), is conducting a clinical trial to determine whether carrying out the procedure prenatally leads to an overall improvement for these children – with acceptable risks.

Future pregnancies

Parents who have given birth to a child with spina bifida or other ONTD may have genetic counseling recommended by their physician to discuss the risk of recurrence in a future pregnancy, as well as vitamin therapy (a prescription for folic acid) that can decrease the recurrence risk for ONTD. Supplemental folic acid, a B vitamin, if taken one to two months prior to conception and throughout the first trimester of pregnancy, has been found to decrease the reoccurrence of ONTDs for couples who have had a previous child with an ONTD.