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Folic Acid- Reducing the Risk of Spinal Cord Birth Defects

by Chelsea Commander, APRN, FNP-C


The Center of Disease Control and Prevention says that women who take folic acid at least one month prior to conception and during the first trimester of the pregnancy will reduce the risk of having a baby with neural tube defects by 50 to 70%. Neural tube defects (NTD) occur at the very early stages of pregnancy, even before most women realize they are pregnant. This defect occurs in over 3,000 pregnancies a year in the United States. There are two types of NTD: open and closed. Open NTD is when the brain or spinal cord is exposed at birth. Closed NTD occurs when the hole exists, but is covered by a layer of skin. Women who are or might become pregnant need folic acid in their diet to prevent this birth defect.

To understand the seriousness of NTD, it is best to learn some details about some of the possible conditions. Some types of open NTD conditions, when the brain tissue protrudes out of the skin from an abnormal opening in the skull, can result in the child being born blind, deaf, and unconscious. These infants are sometimes still born or die within a few hours. Other NTD can be surgically repaired, but may still result in severe neurological dysfunction. One type of closed NTD, spina bifida occulta, is actually benign and results in no symptoms or dysfunction. About 10-15% of the healthy population have this and do not know it. It usually is incidentally found on spinal X-rays. NTD can be identified by ultrasound, blood tests, or amniocentesis, but if it is not detected early on, can be immediately recognized at birth.

As type and level of severity differ among people with NTD, each person with the condition faces different challenges and may require different treatments ranging from surgical to non-surgical. The best way to manage NTD is with a team approach. Members of the team may include neurosurgeons, urologists, orthopedists, physical and occupational therapists, psychologists, and medical social workers. The goal of treatment for NTD is to allow the individual to achieve the highest level of function and independence.

Folic acid, also known as folate, is essential to the prevention of NTD. Folic acid is a vitamin that the body needs to grow and be healthy. Folate is used for the production and maintenance of new cells, for DNA synthesis, and RNA synthesis. Because of this, some research even suggests that folic acid can help prevent other birth defects as well such as cleft lip, cleft pallet, and congenital cardiac abnormalities. To reduce the risk of NTD and other birth defects, doctors recommend that women consume 4mg of folic acid each day at least one month prior to trying to become pregnant and during the first trimester.  Since many pregnancies are unplanned, many expert groups suggest that women of child bearing age should take 4mg per day just to be safe. The neural tube, from which the baby’s brain and spine will develop, begins to form 3 days after fertilization, so it is extremely important to have plenty of folic acid in your system to help support this process. Folic acid is found in many foods, but the man-made or synthetic form in pills is actually better absorbed by our bodies. Folate is found naturally in leafy vegetables like kale and spinach. It can also be found in orange juice or enriched grains like breakfast cereals, breads, pastas, and rice.

Women with previous pregnancies resulting in NTD’s should seek a physician’s advice before attempting to get pregnant. Ask your OBGYN the best way for you to get folic acid in your diet if you are planning on pregnancy.

Sources:

  1. “Folic Acid in Your Pregnancy Diet” Reviewed by Baby Center Medical Adisory Board http://www.babycenter.com/0_folic-acid-in-your-pregnancy-diet_476.bc
  2. Folic acid supplementation can adversely affect murine neural tube closure and embryonic survival Amber Marean, Amanda Graf, Ying Zhang and Lee Niswander 2001
  3. “Folic Acid and Pregnancy” Reviewed by: Elana Pearl Ben-Joseph, MDhttp://kidshealth.org/parent/pregnancy_center/your_pregnancy/preg_folic_acid.html November 2011
  4. “Vitamins and Nutrition in Pregnancy” http://www.nhs.uk/conditions/pregnancy-and-baby/pages/vitamins-minerals-supplements-pregnant.aspx 2011