FOLIC ACID: PREVENT SPINA BIFIDA

Prevent Another Birth Defect

New public health recommendations will prevent most neural tube defects with simple adjustments in the diet. We wish to share this important information with you.

Neural tube defects (NTDs) are a group of birth defects which include spina bifida, anencephaly and encephalocele. These result from failure of the developing brain and spine to close during the first 28 days of pregnancy. There are many causes for this. Some cases result from diabetes during pregnancy. Substances such as alcohol or certain seizure drugs in the mother's system during pregnancy can also account for some cases. There are some genetic syndromes that include neural tube defects as part of a picture of multiple defects. And some families have a slightly increased genetic risk of bearing children with an NTD.

However, research shows that inadequacies in the diet may be the cause of most cases of NTD. These inadequacies could result from an improper diet, or an increased sensitivity or particularly high dietary need some women may have.

Public Health Recommendations for Most Women

Specifically, research shows that 0.4 mg of folic acid (a B-vitamin) in the daily diet of women can prevent at least half of all cases of NTD. The average American woman gets only half this amount in her daily diet. Adding the proper amount of folic acid to the diet may therefore prevent a majority of cases of neural tube defects.

However, women must take adequate amounts of folic acid during the month before conception and through the first trimester of pregnancy. Taking increased folic acid after discovering you are pregnant is too late.

More than half of all pregnancies are unplanned, and most cases of neural tube defect happen without any family history of this birth defect. The U.S. Centers for Disease Control therefore have recommended that: "All women of childbearing age in the United States who are capable of becoming pregnant should consume 0.4 mg of folic acid per day for the purpose of reducing their risk of having a pregnancy affected with spina bifida or other NTDs (neural tube defects)." We will state this more directly: Every sexually active woman from puberty to menopause should take vitamin supplements with folic acid, DAILY.

Many non-prescription brands of multivitamins (Centrum, Stresstabs, Theragran, Unicap, Femiron, Myadec and others) have the sufficient 0.4 mg of folic acid.

Recommendations for Women at High Risk

Women who have previously had a pregnancy with a child with spina bifida, encephalocele or anencephaly are "at risk": they have a slightly (2-3 percent) higher chance of having another pregnancy with a neural tube defect. The research shows that for these women a higher dose, namely 4 mg, of folic acid cuts that risk by more than half. If you are "at risk" and anticipate pregnancy, we advise adding the higher 4 mg daily dose of folic acid, and continuing this through the first three months of your pregnancy.

Women taking the higher dose of 0.4 mg should do so only with medical supervision; this higher dose can hide the signs of vitamin B12 deficiency. And simply taking four or more multivitamins daily is unsafe because this may result in harmful levels of other vitamins, increasing the risk of other birth defects from excessive vitamin A and D. Instead, the recommended way of taking the higher dose is: Folic acid, 1 mg, three tablets daily, plus one prenatal multivitamin tablet containing the higher dose of 1 mg folic acid. Folic acid, 1 mg, four tablets daily, is equally acceptable. If "at risk" women are using an effective method of birth control we still advise dietary supplement with the smaller, 0.4 mg, daily dose.

We will continue to strive to provide the most current and comprehensive care to your child. We are also dedicated to measures that reduce the risk of new cases. We will pay close attention to this area of research. And we will keep you informed of any changes in these recommendations.

CDRC Spina Bifida Team

For more information call the nurse coordinator:
In Portland: Joan Cullen
(503) 494-8085, or (800) 452-3563
In Eugene: Cathleen Amen CPNP,
(503) 346-3575, or (800) 637-0700