If you are pregnant or trying to become pregnant, you have probably heard that you should be taking folic acid. The main reason to do so is to help your baby avoid neural tube defects, which are birth defects that can affect the brain and spinal cord. In this blog post, we will discuss the different types of neural tube defects, as well as the best ways to treat and prevent them.
What is the neural tube?
In the very early days of your baby’s development, they form a flattened, ribbon-like structure that runs down their back and is called a neural tube. By week six of pregnancy, the neural tube has completely closed from a flattened ribbon into a tube, which means that neural tube defects-—that is, problems with how this tube forms—start before some women even know they are pregnant. Because the neural tube eventually gives rise to the brain and the spinal cord, neural tube defects affect these structures.
Types of, and Treatments for, Neural Tube Defects
Spina bifida is the most common of the neural tube defects and can range from mild to severe. In children with spina bifida, the bones of the spine do not fuse completely and part of the spinal cord comes through, sometimes just through the spine, but in more severe cases, through the skin at the base of the spine. Typically, spina bifida is caused by a lack of closure at the bottom of the neural tube. Spina bifida can be diagnosed during pregnancy via blood screening, amniocentesis, or ultrasound or after pregnancy using magnetic resonance imaging, computed tomography or CT scan, or x-rays. Depending upon the severity of the opening in the spine, your care provider might recommend that your baby have surgery to close the opening in utero before birth or shortly after they are born.
Babies and children with mild spina bifida might not have any obvious health problems, but more severe forms can lead to any number of health issues, including paralysis, skin problems, and learning disabilities. If your baby is diagnosed with spinal bifida, your pediatrician will help connect you with specialists such as urologists, neurologists, and physical therapists who will help your child be as healthy as they can be.
Anencephaly is the most severe neural tube defect and is caused by the neural tube not closing at the top, near the developing baby’s head. Babies with anencephaly are missing parts of their scalp, skull, and brain. Another very severe neural tube defect is iniencephaly, where the infant’s head is severely bent backwards. Children with anencephaly and iniencephaly sometimes grow until birth, but often die in the hours and days shortly after they are born.
The most rare neural tube defect is encephalocele, which occurs when part of the brain’s protective covering and the brain itself pokes through the skull, most often at the base of the skull near the neck. While most babies with encephalocele survive, they usually need surgery to close the opening in the skull and make sure the brain is in the proper place. Some complications of encephalocele include: hydrocephalus, where fluid builds up in the brain and can lead to swelling; intellectual disabilities; seizures; and vision or movement problems, including paralysis. The impacts of encephalocele on the baby’s life can vary and are usually more severe if the baby also has other birth defects, which can be especially common in the head and face.
Preventing Neural Tube Defects
People who are more at risk for having babies with neural tube defects include couples who have a family member with a neural tube defect, expectant moms who are obese or have diabetes, and people who take anti-seizure medications. One way to prevent neural tube defects is to take a prenatal vitamin before you even become pregnant. A high-quality prenatal vitamin will have at least 600 micrograms of folic acid, a B-vitamin that is necessary for proper neural tube closure. You can also get folic acid from some foods, including citrus, seeds, nuts, and broccoli. In fact, the United States Food and Drug Administration has approved the addition of folic acid to flours and cereals to help prevent neural tube defects. This means that eating things like tortillas, breakfast cereal, bread, and pasta can also help you get enough folic acid and help your baby’s neural tube, brain, and spine develop properly.
Wyszynski DF. Neural Tube Defects: From Origin to Treatment. Oxford University Press, 2006.