Spina Bifida Risk Reduction Starts Before Pregnancy

Spina Bifida Awareness Month
Spina Bifida Awareness Month

Spina bifida, which means "split" or "open" spine in Latin, is a birth defect in which a fetus’s spine is not formed correctly during pregnancy.  The spinal cord normally ‘zips’ closed early in pregnancy. If it fails to close anywhere along the spinal cord, the cord and nerves can be damaged. The severity of the damage depends on two factors: the size and location of the opening in the spine and whether part of the spinal cord and nerves are affected.

3 Most Common Types of Spina Bifida

  • Myelomeningocele is the most common and most severe form of Spina Bifida. It involves is a visible sac of fluid that is connected to an opening in the baby’s back and contains a portion of the spinal cord and nerves that are damaged. The affected individual can be impacted in many ways, including loss of feeling and even immobility of the legs and feet and hydrocephalus, which is a buildup of cerebrospinal fluid in and around the brain. Surgery is often required days after birth to protect the exposed nerves and the central nervous system from infection.
  • Meningocele involves a sac of fluid, similar to the sac formed with a myelomeningocele, however the spinal cord is not located in the sac. The sac can form at the baby’s neck, back or base of the head. It usually causes little or no nerve damage and the severity of disabilities are generally minor. Treatment often includes surgery within the first few months of life to move the nerves back into the body and to close the hole.
  • Spina Bifida Occulta is the mildest type of Spina Bifida. Myelomeningocele and meningocele both involve sacs of fluid, while spina bifida occulta does not include a sac of fluid attached the the spine, head or neck. It also does not include an opening of the spine, but instead a small gap in the spine and typically no nerve or spinal cord damage. Some people refer to it as “hidden spina bifida” because it usually causes no disabilities.

Cause of Spina Bifida

  • Folic acid, or vitamin B9, is important to a fetus’ health. Folic acid is available as part of a prenatal vitamin and in foods such as leafy vegetables, citrus fruits, beans, and whole grains. Folic acid assists with cell growth and development, and tissue formation.
  • If a pregnant woman has low levels of folic acid in her blood during pregnancy, this can increase the risk that her fetus will develop spina bifida. Unfortunately, she probably will not know that she has low levels of folic acid.  For that reason, doctors strongly suggest taking folic acid as part of a prenatal vitamin before conception and every day during pregnancy.
    • There has been discussion about which is better for pregnancy: folic acid or folate. Folate is naturally occurring and folic acid is naturally occurring and also chemically synthesised. Folic acid absorbs in the body better than folate. There is minimal research on which is better to take during pregnancy.
  • A high fever during early pregnancy can increase the risk of the fetus being affected by spina bifida. It is important for women to protect themselves from getting sick by limiting their exposure to infectious agents. It is good practice to washing hands and keep hands away from the nose, mouth and eyes. If you do develop a high temperature early in pregnancy, contact your doctor immediately.
  • Exposure to the drug valproic, used to control seizures in people who have epilepsy, can also increase the risk of spina bifida. If you use this medication please speak to your doctor before pregnancy, if possible, to learn if there are other medications that might work to control your seizures, or if the risk:benefit ratio is acceptable in your case.
  • Exposures to aromatic solvents (found in paints), chlorinated solvents (found in hot tubs, pools etc.) and Stoddard solvent (found in paint thinner) has been suggested to contribute to the development of spina bifida. It is best to avoid these substances as much as possible especially chlorinated solvents as they are show to have more detrimental effects than aromatic and Stoddard solvents. If you cannot avoid these substances, use gloves and masks whenever possible.

Screening & Diagnosis

  • Alpha-fetoprotein (AFP) test is a blood test that measures the level of AFP in a pregnant woman’s blood stream. Every fetus produces this protein.  However, if there is an extra opening in the fetus, such as an opening in the spine caused by spina bifida, more AFP may enter the mother’s bloodstream, causing her blood AFP level to be elevated. Therefore, a high level of AFP in the mother’s blood increases the chance that the fetus may have spina bifida. However, this is only a screening test, and does NOT mean that the fetus has spina bifida. It simply means that the mother requires additional testing, like an ultrasound and/or an amniocentesis, to gather more information.

More Resources:

CDC Kids Health Spina Bifida Association NIH