Preventing Neural Tube Birth Defects

Preventing Neural Tube Birth Defects

Fassett, Elizabeth

Did you know that neural tube defects (NTDs), such as spina bifida and anencephaly, were among the most preventable birth defects? If all women who could become pregnant consumed 400 micrograms (0.4 milligrams) of synthetic folic acid each day before conceiving and throughout the first trimester, CDC estimates the incidence of NTDs could be reduced by up to 70%.

The neural tube, which develops into the baby’s spinal cord, spine, brain, and skull, forms between the 17th and 30th day after conception, often before a woman knows she is pregnant. An NTD occurs when the neural tube fails to close properly, leaving the developing brain or spinal cord exposed. Anencephaly happens when the upper portion of the neural tube fails to close and is always fatal, either before birth or shortly after birth.

Spina bifida takes place when the lower portion of the neural tube fails to close, leaving an opening in the spine to the spinal cord. The severity of spina bifida varies with the size of the opening in the spine and the level along the spine at which it occurs. Often, children with spina bifida require multiple surgeries. Most babies with spina bifida develop hydrocephalus soon after birth and must have shunts inserted to reduce pressure on the brain. Learning disabilities are common among children with spina bifida. Damage to the spinal cord and spinal nerves might result in paralysis of the legs, requiring splints, crutches, and/or wheelchairs for mobility, and in lack of bowel and bladder control, a source of major concern and embarrassment to those affected. Spina bifida can range from mild, with little or no noticeable disability, to severe, requiring ventilation assistance and a gastrostomy tube. The emotional and financial impact of these birth defects on families can be tremendous. But, the good news is that most of these birth defects can be prevented if all women who are capable of getting pregnant take folic acid daily.

Results from randomized controlled studies led the U.S. Public Health Service in 1991 to make a formal recommendation that all women capable of getting pregnant should consume 400 micrograms of synthetic folic acid every day to reduce the risk of neural tube defects. Since 1998, folic acid fortification of “enriched” cereal grain products (flour, cornmeal, cereals, breads, pasta, and rice) mandated by the Food and Drug Administration and a national education campaign have helped to reduce the incidence of NTDs by approximately 20%. But, more needs to be done. For the average woman, eating fortified foods adds only about one quarter of the daily requirement of folic acid.

The synthetic folic acid in vitamins and fortified foods is about twice as bioavailable as is the natural folate found in some foods. An easy way to ensure that all women get the proper amount of folic acid is to take a multivitamin or a single folic acid supplement or eat a serving of breakfast cereal fortified with 100% Daily Value of folic acid each day in addition to eating a healthy diet with plenty of folate-rich fruits, vegetables, and legumes. The 2004 Gallup survey indicates that about 40% of women, ages 18-45, take folic acid daily. That’s up from 32% in 2003, but it’s not close enough to all women. More than half of the women surveyed said that they would take folic acid daily if their health care provider recommended it. What a challenge for health care providers! Nurses can help educate women of childbearing age and teenage girls about the need to take folic acid daily. CDC has tested messages and created educational materials have been created to assist you.

After extensive research, behavioral scientists at CDC developed different messages to target two groups of women-contemplators of pregnancy, who expect to get pregnant soon, and noncontemplators of pregnancy, who are not thinking about pregnancy in the near future or ever. Women who are contemplating pregnancy tend to do what it takes to have a healthy baby. We should emphasize the importance of timing with them-that folic acid needs to be taken before conception.

Non-contemplators, on the other hand, feel that since they aren’t planning to get pregnant any time soon, if at all, then preparing for pregnancy doesn’t affect them. However, they need to understand that their bodies are ready for pregnancy even if they aren’t. And, 50% of all pregnancies in the U. S. are unplanned. If they are sexually active, they could become pregnant!! Helping them to make this link (about the possibility of pregnancy) might convince them that it is not too soon to change their behavior. Non-contemplators might also be influenced to consume folic acid because of its several possible prevention benefits or the other factors that generally motivate women to take multivitamins. Teenagers might respond to the fact that folic acid is a healthy habit and is needed to make each of those healthy new cells in the body, including “glowing” new skin cells.

The Georgia Folic Acid Coalition (GFAC) asks that you join us and other health professionals to encourage all women who are capable of childbearing to get 400 micrograms of folic acid every day. Women who have had previous NTD-affected pregnancies should take 400 micrograms of folic acid daily until 1-3 months before planning another pregnancy. At that time, they should talk with their health care provider about increasing the dose to 4 milligrams of folic acid daily (10 times the amount recommended for all women) and continue that dosage through the first few months of pregnancy. You can find more information and materials to reinforce this important public health message at the Web sites located in the box below.

January 24-30, 2005 marks the first National Folic Acid Awareness week in the United States. Keep your eyes open for Georgia folic acid promotional events and materials. You can find more information and materials to reinforce this important public health message at the Web sites located in the box below.

For more information and materials:

Centers for Disease Control and Prevention

Web site:

Order free materials: Http:// ncbddd/faorder

Georgia Division of Public Health healthyliving/healthyliving6.shtml

Georgia Folic Acid Coalition

Web site: consumer pagel.htm

March of Dimes

Web site: professionals/professionals.asp

National Council on Fplic Acid

Web site: http ://

Elizabeth Fassett, MS, CHES, and Patricia Mersereau, RN, MN, CPNP, representing the Georgia Folic Acid Coalition

Copyright Georgia Nurses Association Nov 2004-Jan 2005

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