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Do you know that congenital anomalies are the major causes of long term disabilities or deaths in newborn babies? WHO, in 2016, reported that an estimated 3,03,000 newborns die within 4 weeks of birth every year, worldwide, due to congenital abnormalities. Among the most common severe congenital abnormalities include congenital heart defects, neural tube defects and Down Syndrome.
With the changing lifestyle and career progression, increased maternal age, unplanned pregnancies, presence of chronic medical conditions, consanguineous marriages, higher carrier frequency for various genetic disorders, maternal micronutrient deficiency and high risk behaviours, there is an increase in the risk of birth defects. Globally, around 3,00,000 children are born with neural tube defects each year, though this condition is preventable, in the majority of cases. Preconception folic acid is a primary prevention that is now well known, but implementation lags behind the basic science.
Neural tube defects occur early in pregnancy, within the first 4 weeks, so most women will not even know they are pregnant at this point. Cells of the neural plate fold back on themselves to make the neural tube, which will eventually become the brain, vertebral column and spinal cord of the baby. When a neural tube fails to close or remains open, it can lead to anencephaly and spina bifida, which are both serious medical problems.
Concume (400 mcg) of folic acid supplementation every day for at least one month before pregnancy till the first twelve weeks of pregnancy. In high risk patients, it is increased to 4000 mcg every day and has a positive effect on reduction of birth defects.
Diabetes: For women with type 1 or type 2 diabetes, it is essential to control preconception blood sugars before planning to conceive as high sugars can increase a baby’s risk of birth defects (NTD), stillbirths and other complications.
Obesity: BMI of 30 or higher before pregnancy can increase complications during pregnancy, including serious birth defects. So it is ideal to reach a healthy weight before getting pregnant.
Learning about both parents’ family health histories gives the baby the best start possible. If either of the baby’s father or mother have a family health history of a birth defect, developmental disability or genetic disease, one can find and address potential health problems early.
In mothers who carry MTHFR gene (detected on genetic testing) and are more prone to neural tube defects, folic acid is the only form of folate that has been shown to prevent neural tube defects
Medication use during pregnancy can influence the chance of having a neural tube defect affected pregnancy. Some medications used to treat seizures have been associated with increased chances of birth defects Pain medications (opioids and NSAIDs) are more likely to have babies affected with spina bifida or other birth defects. Pregnant mothers should avoid usage of any antibiotics without medical advice.
Overheating or fever can influence the chance of having a neural tube defect affecting pregnancy. So, pregnant mothers can protect their developing babies by protecting themselves against infections, treating fever promptly and limiting environmental exposures that increase core body temperatures.
It is recommended to start a folic acid supplement (multivitamin, prenatal vitamin) containing 0.4 mg once per day, beginning at least one month prior to attempting conception and continuing throughout pregnancy.
Common food sources of folate include legumes, such as cooked dried beans, peas, lentils and edamame (green soybeans), dark green vegetables such as asparagus, avocado, spinach, broccoli, romaine lettuce, beets, brussels sprouts, green peas, oranges and orange juice, and wheat germ, sunflower seeds, yeast extract like marmite, and peanuts.
All prenatal and multivitamins contain at least 0.4 mg of folic acid. This dose should ensure adequate folate levels during organogenesis, which occurs primarily in the first trimester, and also later in pregnancy, when folate is required to meet the growth and probable developmental needs of the fetus, and maternal needs. Prenatal ultrasound done at 12 weeks and 18/19 weeks of gestation, by a fetal medicine expert, especially in high risk cases, can help in early detection and prognostication of such pregnancies.
Neural tube defects have a dismal prognosis and with expert guidance, pregnancies can have healthy and happy outcomes.