How to prevent Spina Bifida (congenital neural tube defect)?

From the Guidelines

To prevent spinal bifida, women of childbearing age should take 400 micrograms (0.4 mg) of folic acid daily, ideally starting at least one month before conception and continuing through the first 12 weeks of pregnancy. This recommendation is based on the strongest and most recent evidence from the U.S. Preventive Services Task Force 1. Women with higher risk factors, such as a previous pregnancy affected by neural tube defects, should take a higher dose of 4 mg of folic acid daily under medical supervision. Folic acid can be obtained through prenatal vitamins or separate supplements available over-the-counter. Additionally, eating folate-rich foods like leafy greens, citrus fruits, beans, and fortified grains can complement supplementation. It is also important to avoid alcohol, smoking, and maintain good blood sugar control if diabetic. Folic acid is crucial because it supports the proper development of the neural tube, which forms the baby's brain and spinal cord during the first 28 days after conception—often before many women know they're pregnant. This timing makes preventive supplementation particularly important, as neural tube defects like spina bifida occur when this structure doesn't close properly during early development.

Some key points to consider:

• The U.S. Preventive Services Task Force recommends that all women planning pregnancy take a daily multivitamin containing folic acid at a dose of 0.4 to 0.8 mg beginning at least 1 month before conception and continuing through the first trimester, to reduce the risk for neural tube defects 1.
• Women with a history of a fetus or child with a neural tube defect or having a first-, second-, or third-degree relative with such a defect are at higher risk and should take a higher dose of folic acid 1.
• Maternal medical conditions, such as diabetes and obesity, have also been associated with an increased risk of neural tube defects 1.
• Folic acid supplementation has been shown to reduce the risk of neural tube defects in offspring, with a protective effect observed in studies using multivitamins containing 0.8 mg (800 μg) of folic acid 1.

From the FDA Drug Label

DIETARY FOLIC ACID SUPPLEMENTATION BOTH PRIOR TO AND DURING PREGNANCY SHOULD BE ROUTINELY RECOMMENDED TO PATIENTS CONTEMPLATING PREGNANCY. Evidence suggests that pregnant women who receive folic acid supplementation may be at decreased risk for congenital neural tube defects in their offspring compared to pregnant women not receiving folic acid Taking folic acid supplements before getting pregnant and during early pregnancy can lower the chance of having a baby with a neural tube defect.

To prevent spinal bifida, folic acid supplementation is recommended both prior to and during pregnancy. This can help decrease the risk of congenital neural tube defects, including spina bifida. However, it is essential to note that the effectiveness of folic acid supplementation in reducing the risk of neural tube defects in women taking valproate is unknown 2, 2, 2.

From the Research

Prevention of Spinal Bifida

To prevent spinal bifida, the following measures can be taken:

• Consume 400 micrograms of folic acid daily, as recommended by the US Public Health Service 3, 4, 5, 6, 7
• For women who have previously had an NTD-affected pregnancy, increase the intake of folic acid to 4000 micrograms per day beginning at least 1 month before conception and continuing through the first trimester 3, 4
• Eat a balanced diet that includes folate-rich foods such as orange juice, green leafy vegetables, and beans, although it is difficult to obtain the recommended 400 micrograms daily through diet alone 5
• Take prenatal vitamins that contain folic acid during pregnancy 6
• Consider consuming fortified foods such as cereal grain products that contain folic acid, although not all countries have instituted folic acid fortification programs 6

Target Groups for Prevention

Public health campaigns to promote the consumption of folic acid should target:

• Women of childbearing age who are capable of becoming pregnant 3, 4, 5, 6, 7
• Women who are young, unmarried, obese, smoke, eat few fruits and vegetables, and have a low level of education 7
• Women who have previously had an NTD-affected pregnancy 3, 4

Importance of Folic Acid

Folic acid can reduce the occurrence of spina bifida and anencephaly by at least 50% when consumed daily before conception and during early pregnancy 3, 5, 6, 7 Folic acid supplements can prevent 50%-70% of neural tube defects, which include spina bifida and anencephaly 7