Folic acid supplement reduces risk of ‘spina bifida’

SpinA bifida is a defect in the spinal cord that some babies are born with. Hydrocephalus is a condition where there is an accumulation of fluid in the brain. While the two conditions are different, some babies have both conditions.

Tuesday this week (October 25) was World Spina Bifida and Hydrocephalus Day, a day when efforts are made to increase awareness and understanding of these conditions. We will deal only with spina bifida this week.

Spina bifida occurs when a baby’s spine and spinal cord do not develop properly in the womb.

normally a baby’s neural tube, the structure that eventually becomes the baby’s brain and spinal cord and the tissues that enclose them, closes by the 28th day after conception. With spina bifida part of the neural tube does not close or develop properly. This causes problems in the spinal cord and the bones of the spine.

Types

Spina bifida can be mild or severe. Spina bifida occulta normally has no symptoms, though there may be a tuft of hair, small dimple or birthmark on the skin in the area of the spine. Generally the condition will only be discovered if an ultrasound scan or MRi is performed.

Meningocele is a type of spina bifida where a sac of fluid, without the spinal cord, comes through an opening in your baby’s back. it usually causes little or no damage.

Myelomeningocele is the most severe type of spina bifida. With this type the spinal canal remains open along several vertebrae in the lower or middle back. Membranes and the spinal cord or nerves protrude from a sac, though skin sometimes covers it.

Causes

it is not certain what causes spina bifida. However, a family history of neural tube defects and a deficiency in vitamin B-9, the synthetic form of which is folic acid, in the mother have been identified as risk factors. Some medicines, such as some anti-seizure medicines, taken during pregnancy seem to cause neural tube defects. Women with poorly controlled diabetes have an increased risk of having a baby with spina bifida. Obesity before pregnancy is associated with an increased risk as well.

Symptoms

Spina bifida may cause only minimal symptoms or minor physical problems. However, severe spina bifida can lead to significant physical conditions, depending on the size and location of the neural tube defect, whether skin covers the affected area and which nerves protrude from the spinal cord.

Complications

Among possible complications are walking problems and sometimes paralysis, a curved spine, abnormal growth, hip dislocation, bone and joint deformities and muscle contractions. There are generally bladder and bowel control problems with myelomeningocele.

Babies born with myelomeningocele commonly experience an accumulation of fluid in the brain, the condition known as hydrocephalus, which requires surgery.

Chiari malformation type two is a common problem with the brain in children who have the myelomeningocele type of spina bifida. This can cause problems with breathing and swallowing. Rarely, compression on this area of the brain occurs and surgery is needed to relieve the pressure.

Children with spina bifida may develop wounds on their feet, legs, buttocks or back. Because they may be unable to feel blisters or sores, these can turn into deep wounds or foot infections that are hard to treat.

Where surgery is required to limit the degree of disability, spinal nerves may bind to the scar where the defect was closed surgically, restricting growth of the spinal cord as the child grows. This may cause loss of muscle function in the legs, bowel or bladder. Further surgery can limit the degree of disability. Both children and adults with spina bifida, particularly myelomeningocele, may have sleep apnoea or other sleep disorders

Some babies with myelomeningocele may develop meningitis, an infection in the tissues surrounding the brain. This potentially lifethreatening infection may cause brain injury.

More problems may arise as children with spina bifida get older, such as urinary tract infections, gastrointestinal disorders and depression.

Children with myelomeningocele may have learning disorders, such as problems paying attention and difficulty learning reading and maths.

Children diagnosed with myelomeningocele should be monitored by healthcare professionals throughout their lives

Treatment

Treatment depends on the severity of the condition. Spina bifida occulta often doesn't require any treatment but other types of spina bifida do. nerve function in babies with spina bifida can worsen after birth if the condition is not treated.

prenatal surgery for spina bifida (foetal surgery) is sometimes possible where there is a healthcare facility with experienced foetal surgery experts, a multi-specialty team approach and a neonatal intensive care unit. Typically the team would include a foetal surgeon, paediatric neurosurgeon, maternal-foetal medicine specialist, foetal cardiologist and neonatologist.

Such surgery normally takes place before the 26th week of pregnancy. Surgeons expose the pregnant mother's uterus surgically, open the uterus and repair the baby's spinal cord. in some patients, this procedure can be performed less invasively with an instrument inserted into the uterus.Children with spina bifida who have foetal surgery may have reduced disability and be less likely to need crutches or other walking devices. Surgery while still in the womb may also reduce the risk of hydrocephalus.

However, foetal surgery can only be performed where there are the necessary specialists and at a facility with a neonatal intensive care unit, since there is a the risk of premature birth.

Prevention

Folic acid, taken in supplement form, ideally starting at least one month before conception and continuing through the first trimester of pregnancy, reduces the risk of spina bifida and other neural tube defects. Because most women do not know when they will conceive until they have done so, women who are planning pregnancy or could become pregnant are often advised to take a folic acid supplement daily.

Folate is present naturally in many foods, including beans, peas, citrus fruits and juices, egg yolks, milk, avocados and dark green vegetables such as broccoli and spinach. However, your body does not absorb folate as easily as synthetic folic acid. it is unlikely you will have enough folate through diet alone, which is why a folic acid supplement is important to reduce the risk of spina bifida and possibly other birth defects, including cleft lip, cleft palate and some congenital heart defects.

if you have spina bifida or if have previously given birth to a child with spina bifida, you will need extra folic acid before you become pregnant.

if you are taking anti-seizure medications or you have diabetes, you may also benefit from a higher dose. However, check with your doctor before taking additional folic acid supplements.

The information in this article is provided as a public service by the Cimas iGo wellness programme, which is designed to promote good health. it is provided for general information only and should not be construed as medical advice. Readers should consult their doctor or clinic on any matter related to their health or the treatment of any health problem. — igo@cimas. co.zw or whatsapp 0772 161 829 or phone 024-2773 0663