The Benefits of Folic Acid Supplementation on Spina Bifida Prevention
Spina bifida is a congenital condition that affects the spine and spinal cord development during pregnancy but is usually apparent at birth. It is a type of neural tube defect (NTD), which occur when the neural tube that forms the baby’s brain and spinal cord fails to close properly (1).
This condition can have a significant impact on individuals' lives, leading to physical disabilities, neurological complications, and other health challenges.
Types of Spina Bifida
There are different types of spina bifida, including spina bifida occulta, meningocele, and myelomeningocele.
- Spina bifida occulta: is the mildest form, often going unnoticed as it may not cause visible symptoms or require treatment.
- Meningocele: involves a sac of fluid protruding through an opening in the spine.
- Myelomeningocele: is the most severe form, where the spinal cord and its protective covering protrude through an opening, leading to neurological impairments.
Individuals with spina bifida may face various challenges throughout their lives. These challenges can include; physical disabilities, such as paralysis, orthopedic complications, bladder and bowel control issues, and difficulties with mobility. They may also experience learning disabilities, social and emotional difficulties, and an increased risk of developing secondary conditions, such as hydrocephalus and latex allergies.
Causes of Spina Bifida
The exact causes of this spina bifida are known; however, many things can increase a baby’s risk of developing the condition (2). Spina bifida can have various causes, including genetic factors, environmental influences, and a combination of both. Certain risk factors, such as maternal diabetes, obesity, and a family history of neural tube defects, can increase the chances of a baby being born with spina bifida.
Symptoms of Spina Bifida
Most people with spina bifida can have surgery to close the opening in the spine (3, 4). But the nervous system would have been damaged, which can lead to problems such as:
- Weakness or total paralysis of the legs
- Bowel incontinence and urinary incontinence
- Loss of skin sensation in the legs and around the bottom – the child is unable to feel hot or cold, which can lead to accidental injury
- Many babies will have or develop hydrocephalus (a build-up of fluid on the brain), which can further damage the brain
- Most people with spina bifida have normal intelligence, but some have learning difficulties.
Life Expectancy of Spina Bifida Patient
Many children with spina bifida live into adulthood with the proper treatment and care. The estimated mean age for a person with spina bifida is 40 years. Spina bifida is a permanent, incurable condition. Although living with it is often difficult, many individuals can lead independent and fulfilling lives. (5)
The prevalence of spina bifida varies across different populations, with some regions reporting higher rates than others. Spina bifida is found in about 6 babies out of every 10,000 (0.06%).
- Hispanic: 3.80 per 10,000 live births
- Non-Hispanic Black or African- American: 2.73 per 10,000 live births
- Non-Hispanic white: 3.09 per 10,000 live births (6).
Diagnosing Spina Bifida
Spina bifida is often detected during the mid-pregnancy anomaly scan, which is offered to all pregnant women between 18 and 21 weeks of pregnancy. If tests confirm that your baby has spina bifida, the implications will be discussed with you.
This will include a discussion about the possible problems associated with the condition, the treatment and support your child may need if you decide to continue with the pregnancy, and what your options are regarding ending the pregnancy, if that is your choice.
Prevention of Spina Bifida
Addressing spina bifida through preventive measures is crucial in reducing its prevalence and the associated burden. One such preventive strategy is folic acid supplementation, which has shown promising results in reducing the risk of spina bifida and other neural tube defects (7).
Folic Acid as An Essential Nutrient
Folic acid, also known as folate or vitamin B9, is a water-soluble vitamin that plays a vital role in various biological processes. It is necessary for the production and maintenance of new cells, including DNA synthesis and repair. Adequate folic acid intake is essential during rapid cell division and growth, such as in pregnancy.
Folic acid can be obtained through dietary sources, including leafy green vegetables, citrus fruits, legumes, and fortified cereals. However, it can be challenging to meet the recommended daily intake through diet alone. For this reason, folic acid supplementation is often recommended, especially during pregnancy.
During pregnancy, folic acid is essential for proper fetal development, particularly in the early stages of neural tube formation. Insufficient folic acid intake during this critical period can increase the risk of neural tube defects, including spina bifida. This is why healthcare professionals recommend women of childbearing age take a daily folic acid supplement to ensure adequate intake, even before they become pregnant.
Folic Acid and Spina Bifida Prevention
Research has consistently shown a strong link between folic acid supplementation and a reduced risk of neural tube defects, including spina bifida. Folic acid plays a crucial role in the development of the neural tube, and its deficiency can interfere with the proper closure of this structure during early embryonic development.
The mechanism behind how folic acid reduces the risk of spina bifida is not yet fully understood. But it is believed that folic acid helps in DNA synthesis, cell division, and tissue formation. Providing sufficient folic acid can significantly reduce the risk of neural tube defects.
Public Health Measures and Awareness
Seeing the importance of folic acid in spina bifida prevention, public health measures have been implemented to increase folic acid intake in the population. One notable measure is folic acid fortification, where folic acid is added to staple food products, such as flour, to ensure a consistent intake across the population.
In addition to fortification, public health campaigns and education play a vital role in raising awareness about the importance of folic acid supplementation. These initiatives aim to reach women of childbearing age and provide them with accurate information about the benefits of folic acid and the appropriate dosage. Successful campaigns have resulted in increased folic acid knowledge, awareness, and adherence to supplementation guidelines.
Overcoming Challenges and Future Directions
While folic acid supplementation has shown great promise in spina bifida prevention, some challenges remain. Specific populations, such as low-income groups or those with limited access to healthcare, may face barriers to obtaining adequate folic acid intake. Efforts are needed to address these disparities and ensure that all women have access to affordable and culturally appropriate folic acid supplementation.
Ongoing research is focused on further understanding the genetic and environmental factors involved in spina bifida development. This knowledge can help identify additional preventive strategies and personalized approaches to reduce the risk of spina bifida and improve outcomes for affected individuals.
Continued efforts to improve folic acid supplementation programs and public health policies are essential. This includes monitoring the effectiveness of fortification programs, evaluating the impact of public health campaigns, and staying updated with the latest scientific research. By working together, healthcare professionals, policymakers, and communities can make significant progress in spina bifida prevention and ensure a healthier future for all.
Conclusion
Spina bifida is a complex condition that can have a profound impact on individuals' lives. However, through preventive measures, such as folic acid supplementation, we have the potential to significantly reduce the risk of spina bifida and improve outcomes for affected individuals. The research linking folic acid to spina bifida prevention is robust and compelling, highlighting the importance of this essential nutrient during pregnancy. Public health measures, such as folic acid fortification and awareness campaigns, have played a crucial role in increasing folic acid intake and reducing the prevalence of spina bifida. By working together, we can make a lasting impact on the lives of individuals affected by spina bifida and strive for a future where this condition is significantly reduced or eliminated.
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