What is spina bifida, and are there ways to prevent it? A doctor explains
Kyiv • UNN
Every year, up to 300,000 children are born with spina bifida. Doctors advise starting to take folic acid even before conception.
October 25 is World Spina Bifida and Hydrocephalus Awareness Day. Obstetrician-gynecologist, Candidate of Medical Sciences, and head of the postpartum department at the capital’s Perinatal Center Vladyslav Yavir told UNN in a comment about what these developmental defects are and what prevention of their occurrence exists.
Every year, up to 300,000 children worldwide are born with a diagnosis of spina bifida. In fact, this figure may be higher, as not all countries record information about this fetal developmental defect as a separate item in medical statistics.
Spina bifida — what it is and how this developmental defect is linked to hydrocephalus
Spina bifida (split spine) is a congenital neural tube defect (an embryonic structure from which the child’s central nervous system develops), in which the formation and closure of the structures of the spinal canal are disrupted. In severe forms, particularly myelomeningocele, the membranes and neural structures of the spinal cord may protrude through the spinal defect.
As Vladyslav Yavir explains, severe forms of spina bifida are associated with impaired normal circulation of cerebrospinal fluid (CSF).
"As a result, CSF may accumulate in the ventricles of the brain, causing hydrocephalus to develop. At the same time, hydrocephalus does not occur in all children with spina bifida," the doctor says.
Prevention with folic acid
Taking folic acid can help prevent the development of spina bifida.
"Timely intake of folic acid can significantly reduce the risk of neural tube defects. According to research, a substantial proportion of such defects can be prevented by ensuring an adequate supply of folates to the body even before pregnancy begins. However, even proper prevention does not guarantee the complete elimination of the risk," Yavir explains.
According to the doctor, the neural tube forms and closes very early — approximately by the 28th day after fertilization.
"That is why folic acid supplementation should begin before pregnancy, preferably 1–3 months before conception," the doctor says.
According to him, there is a standard preventive dose of folic acid. However, there are high-risk groups for whom significantly higher doses may be recommended.
"First of all, these include women with a previous pregnancy complicated by a neural tube defect, patients with pregestational diabetes mellitus, and women taking certain medications (antiepileptic drugs)," Yavir explains.
High-dose supplementation is usually started before conception and continued until the end of the 12th week of pregnancy.
"It is important to emphasize that a high dose of folic acid should not be prescribed independently. It must be determined by a doctor after assessing individual risk factors.
That is why I always emphasize the importance of preconception care: the best time to prevent many congenital developmental defects is before pregnancy begins," the doctor says.
Folates can be obtained from foods such as green leafy vegetables, legumes, and citrus fruits. However, as the obstetrician-gynecologist explains, even a balanced diet does not always provide a sufficient amount of folates to prevent neural tube defects. Natural folates have lower bioavailability compared with synthetic folic acid, and some of them are destroyed during heat treatment.
"That is why the WHO and CDC recommend that women planning a pregnancy or capable of becoming pregnant take 400 mcg (0.4 mg) of folic acid daily in the absence of indications for a higher dose. Proper nutrition is important, but it does not replace the recommended prevention with folic acid," the doctor says.
Detecting developmental defects during pregnancy
Modern prenatal diagnostics makes it possible to detect spina bifida during the child’s intrauterine development. The primary diagnostic method is an ultrasound examination (ultrasound scan).
- First-trimester ultrasound (11–13 weeks + 6 days): an experienced specialist may already suspect open spina bifida based on characteristic ultrasound signs, including changes in the fetal intracranial structures.
- Second-trimester ultrasound (18–22 weeks): the main stage for a detailed assessment of fetal anatomy. It makes it possible to detect a spinal defect, possible protrusion of the spinal cord membranes and neural structures, as well as characteristic changes in the brain.
- Biochemical screening: an elevated level of alpha-fetoprotein (AFP) in the mother’s blood during the second trimester may indicate an open neural tube defect, but in itself does not confirm the diagnosis.
Timely detection of the defect makes it possible to conduct an in-depth examination, assess the prognosis, and determine the further management plan for the pregnancy.
"Today, a diagnosis of spina bifida does not mean that treatment options are unavailable. In specialized centers, fetal surgical closure of myelomeningocele may be possible when clearly indicated. Studies have shown that, in carefully selected cases, such an intervention may reduce the need for cerebrospinal fluid shunting and improve the child’s motor function. Surgical treatment after birth is also available. In such cases, the defect is usually closed during the first days of the child’s life. If hydrocephalus is present, additional neurosurgical treatment may be required," explains Vladyslav Yavir.
At the same time, the doctor emphasizes that none of these methods guarantees the complete elimination of neurological impairments. In addition, surgery carries serious risks, so the decision is made by a multidisciplinary team after detailed counseling of the parents.
That is why preventive folic acid supplementation before pregnancy remains the most optimal approach. It should be started at least one month before planned conception, and, as the doctor clarifies, preferably three months beforehand.
"This is a simple, accessible, and scientifically proven way to significantly reduce the risk of severe congenital neural tube defects. As an obstetrician-gynecologist, I always emphasize: a healthy pregnancy begins not with two lines on a test, but with a conscious attitude toward one’s own health even at the stage of planning it!
After all, the best treatment is the one whose need we were able to prevent through timely prevention," Yavir concluded.
Attention!
This material is for informational purposes only and is not medical advice or a treatment recommendation. It does not replace consultation, diagnosis, or treatment by a specialist and may not serve as a basis for self-prescribing medications. If you are planning a pregnancy or are already pregnant, consult an obstetrician-gynecologist or family doctor.