Folic Acid

What is Spina Bifida?

Spina bifida (or neural tube defect) is caused by a hole, anywhere along a baby’s spine or brain; the location and size of this hole will impact the severity of outcome for the baby. Spina bifida can be a devastating abnormality, resulting in life-long neurological impairment. Many women with this diagnosis will choose to terminate the pregnancy, but it is definitely a personal decision. There are teams of people from areas such as: paediatrics, social work, genetics and even parents of babies with neural tube defects, who can provide couples with the information they need to make the decision whether or not to terminate.

How do I know if my baby has it?

Most spina bifida can be detected by a combination of a blood test (alpha-fetoprotein: αFP) after 15 weeks into your pregnancy and an ultrasound of the spine and brain, typically between 18 and 20 weeks. Because some spina bifida can be associated with a genetic abnormality, the specialists discussing your baby’s findings may suggest an amniocentesis and a more detailed ultrasound and consult in a high-risk centre.

How do I prevent it?

The incidence of spina bifida in Canada varies by province but is approximately 1/1000 pregnancies. The best way to protect your baby is to start taking folic acid at least 3 months before you get pregnant. This will decrease the chance of your baby developing spina bifida by about 50%. If you wait until you get pregnant or miss your period to start folic acid supplements, you are too late. The spine forms like an open book — and it closes around 42 days from the first day of your last menstrual period, which is approximately 28 days after you ovulate or 14 days after you have missed a period.

You only need to take a daily dose of 400 µg, though most vitamin supplements (including prenatal vitamins) contain 1000 µg (1g). Women who have diabetes or are taking certain epilepsy medications, women who have previously had a baby with spina bifida and women who are obese need to take higher doses of folic acid; ask your health care provider what is right for you.

Because almost half of all pregnancies are unplanned and unfortunately, many women are not on folic acid when they get pregnant, Canada and many other countries around the world require fortification of grains and pastas to increase the intake of folic acid in the population. Since this was done in Canada in 1988, the incidence of spina bifida has decreased.

New evidence suggests that folic acid supplements also decrease the risk of your baby developing other abnormalities such as: congenital heart disease, urinary tract problems, facial clefts, limb defects and some pediatric cancers. Although diet alone cannot provide enough folic acid for your developing baby, there are several foods that are good sources of folic acid, they include: fortified grains, spinach, lentils, chick peas, asparagus, broccoli, peas, brussels sprouts, corn and oranges. For more information on the benefits of folic acid and other sources of dietary folate, visit Health Canada.