Prevention and Treatment
Adequate folate, also called folic acid, is the primary prevention tool. Recent evidence suggests that folic acid supplementation could reduce the incidence of neural tube defects (NTDs) by up to 70%, but the protection it provides must be in place at the time of conception. A woman should begin taking folate a month before becoming pregnant and continue throughout her pregnancy. To ensure this, it is generally recommended that all women of childbearing age get at least 400 micrograms of folate a day. Since folic acid is a water-soluble vitamin, it must be constantly replenished. In addition to supplements, folic acid can be found in dark green vegetables and some fruit. Most grain products in the U.S. are good sources because they have been fortified with added folic acid.
Women who have spina bifida, or who already have a child with spina bifida, or who are otherwise considered at an increased risk of having a baby with an NTD may be given a prescription for about 10 times the recommended dose for several months before becoming pregnant. This higher dose is not recommended for the general population.
There is no cure for NTDs, and any nerve damage or loss in function is permanent. Monitoring is initiated as soon as a neural tube defect is detected. Those with a mild NTD may not require treatment, but many of those affected require one or more surgical interventions with needs that begin at birth and change over time. New options are constantly emerging and parents should work with their healthcare providers to determine which treatments are right for their child.
Usually, a baby born with spina bifida requires surgery to close the spinal defect and protect exposed nerves from further damage. The surgery is typically performed immediately following delivery or during the first few days of life.
However, a study sponsored by the Eunice Kennedy Shriver National Institute of Child Health and Human Development suggests that there are better health outcomes when prenatal surgery is performed between 19 and 26 weeks of pregnancy as opposed to waiting until the baby is born. The study showed that covering the neural tube defect with layers of the fetus's tissue resulted in better motor function at 30 months age than in babies who received surgery post-delivery. Babies who received prenatal surgery also showed a reduced need for shunt placement. There are increased risks to the mother and baby with prenatal surgery, however. The mothers required follow-up monitoring and cesarean deliveries, and many of the babies were born prematurely. These specialized surgeries are being performed in a few centers, and research into the use of this type of surgery to address NTDs is continuing. (See the Related Pages tab for links to sites with more information.)