What are Neural Tube Defects (NTDs)

Neural Tube Defects (NTDs) affect 300,000 births each year worldwide. They are one of the most common birth defects and manifest themselves as:

  • spina bifida: where the fetal spinal column doesn’t completely close off
  • anencephaly: characterized with little or no brain
  • encephalocele: affecting the skull
  • iniencephaly: characterized by severe neck problems

Preventing Spina Bifida and Anencephaly

Why should I take folic acid?

With the aim of preventing NTDs, the US Public Health Service recommends that all women of reproductive age consume 400 mcg of folic acid per day. Dreaming of Baby discusses Neural Tube Defects, the role of folic acid in aiding in their prevention, as well as prognosis when an NTD is diagnosed with ‘everyone’s favorite Ob/Gyn’, Dr. Angela Jones.

Folic acid is a form of the naturally occurring B vitamin known as folate and is most important for a healthy pregnancy. For a woman expecting multiples, the required amount of folic acid increases.

Dr. Angela Jones: “The deal with folic acid is this. It helps decrease an expectant mother’s risk of having a baby with neural tube defects. Whenever you hear the phrase “neural tube”, think brain and spinal cord malformation. Folic acid is critical during the development of the brain and spinal cord.”

Regardless of its importance, a lot of women are still not taking folic acid prior to conception. As Dr. Jones explains:

Dr. Angela Jones: “Most prenatal vitamins are not even initiated prior to the new Ob/Gyn visit. By this time, the organ systems have pretty much formed. What women, particularly in the United States, have in their favor is that lots of cereal and flour products have folic acid in them. Also, if a mom-to-be has been taking a prenatal vitamin, more than likely they will have gotten the recommended amount of folic acid they need.”

Neural Tube Defects: Diagnosis and Prognosis

Neural Tube Defects can be diagnosed before birth as they would likely be visible on ultrasound. The most common NTD is spina bifida; as Dr. Jones explains, brain malformations such as anencephaly is another common finding.

We asked Dr. Jones what the prognosis would be once spina bifida is identified on ultrasound and if the condition can be treated in-utero:

Dr. Angela Jones: “This depends on the severity. There are in-utero surgical options. I have been practicing for over 12 years and haven’t personally had a patient or known of a patient that selected this option. Prognosis depends on the size of the defect and the location of the defect. With all of today’s advancements and technologies; a lot of individuals affected with spina bifida lead productive lives.”

The prognosis for anencephaly is unfortunately not a positive one:

Dr. Angela Jones: If the infant is born alive, survival is typically a few hours to days.

Experiencing a pregnancy with neural tube defects can be a challenging experience and also lead to concerns about a possible subsequent pregnancy. As Dr. Angela Jones explains,

Dr. Angela Jones: “Most of the literature quotes a 2-4% risk of recurrence. If you have a history of a prior pregnancy affected by a neural tube defect, your folic acid requirement is increased to prevent recurrence.”

There are no tests done prior to trying to conceive with the aim of lowering such risks.

Dr. Angela Jones: “This is why preconceptional counseling; i.e., meeting with the couple prior to conception is of paramount importance. To get a good medical/family history and take all necessary steps (initiating a prenatal vitamin, extra folic acid if needed, losing weight, getting better control of chronic medical conditions such as diabetes or hypertension, etc.) to ensure a mom-to-be is at her best to better help ensure a healthy pregnancy.”

Dr. Angela Jones: “There are screening tests offered during pregnancy. For neural tube defects, the AFP, Alpha Fetal Protein, blood test is drawn in the second trimester. The MS-AFP: maternal serum alpha-feto protein is typically drawn between 15-20 weeks.”

 

Even if you’re not planning on becoming pregnant in the short term, you still need folic acid. Folic acid helps our bodies make new cells on a daily basis. Apart from this, NTDs occur in the first weeks of pregnancy, before even realizing you might be pregnant. Optimizing your health prior to pregnancy is hence imperative.

 

Dr. Angela Jones is Astroglide‘s Sexual Health Advisor

 

Want to read more about Folic Acid?

Preventing a Folic Acid Deficiency in Pregnancy
The Effects of a Folic Acid Deficiency on a Mom-To-Be’s Health
How Folic Acid Affects Fertility and Pregnancy
Folic Acid and the Reduction of Pesticide-related Autism Risk
The Cost of Premature Birth
Fertility Boosting Foods
Before Getting Pregnant

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