Spina bifida is when a baby's spine and spinal cord does not develop well in the womb, causing a space in the spine.
Spina bifida is a kind of neural tube defect. The neural tube is the shape that finally develops into the baby's brain and spinal cord.
The neural tube begins to form in early pregnancy and closes about 4 weeks after conception.
In spina bifida, part of the neural tube does not mature or close properly, resulting in defects in the spinal cord and bones of the spine (vertebrae).
It's not known what causes spina bifida, however, a lack of folic acid before and in the early stages of pregnancy is an important risk factor.
Types of spina bifida
There are various types of spina bifida, including:
- Myelomeningocele – This is the usually most severe type of spina bifida. The baby's spinal canal stays open alongside several vertebrae in the back, thereby allowing the spinal cord and protective membranes surrounding it to push out and form a sac in the baby's back.
- Meningocele – This is another serious type of spina bifida whereby the protective membranes round the spinal cord thrust out through the spine; the spinal cord typically develops normally so surgery can often be used to remove the membranes without causing damage to the nerves.
- Spina bifida occulta – The most common and minor type of spina bifida. One or more vertebrae does not form well, but the gap in the spine is very little. Spina bifida occulta does not normally cause any problems and most people are not aware they have it.
These pages focus on myelomeningocele, the most severe type of spina bifida, and this is the type usually referred to each time the term spina bifida is used.
Symptoms of spina bifida
Most people with spina bifida can have surgical operation to close the opening in the spine.
But the nervous system will already have been damaged, which can result to problems such as:
- Weakness or overall paralysis of the legs.
- Bowel incontinence and urinary incontinence.
- Loss of skin sensation in the legs and around the bottom – the child is not able to feel hot or cold, which can lead to unintentional injury.
Many babies will have or develop hydrocephalus (a build-up of fluid on the brain), which can cause further injury to the brain.
Most people with spina bifida have normal intelligence, however, some have learning problems.
Causes of spina bifida
The cause of spina bifida is unknown, however, a number of factors can increase the risk of a baby developing the condition. These include:
- Low folic acid consumption during pregnancy.
- Having a family medical history of spina bifida.
- Medicines – taking certain medications such as valproic acid (used to avert seizures) during pregnancy has been linked to a bigger risk of having a baby with spina bifida.
Diagnosing spina bifida
Spina bifida is regularly noticed during the mid-pregnancy anomaly scan, which is offered to every pregnant women between 18 and 21 weeks of pregnancy.
If medical tests confirm that your baby has spina bifida, the implications will be discussed with you.
This will include a discussion about the likely problems related to the condition, the treatment and support your child may need if you choose to continue with the pregnancy, and what your options are concerning terminating the pregnancy, if that's your choice.
Tests after birth
Once the baby is born, different tests may be done to find out how bad the condition is and help decide which treatments are likely to be the best option.
Tests may include:
- Monitoring your child's head growth and performing a brain scan, using an ultrasound scan, CT scan or MRI scan, to test for hydrocephalus (excess fluid on the brain).
- Ultrasound scans of the bladder and kidneys to see if your baby stores their pee normally.
- An evaluation of your baby's movements to check for paralysis.
Surgery to repair the spine will normally be recommended right after your baby is born.
Treating spina bifida
Treatments for the symptoms associated with spina bifida include:
- Surgery right after birth to close the opening in the spine and treat hydrocephalus.
- Therapies to help make day-to-day life easier and increase independence, such as physiotherapy and occupational therapy.
- Assistive equipment and mobility equipment, such as a wheelchair or walking aids.
- Treatments for bowel and urinary problems.
With the right treatment and care, many children with spina bifida live well into adulthood.
It can be a difficult condition to live with, but many adults with spina bifida are able to lead independent and fulfilling lives.
Preventing spina bifida with folic acid
The best way to avert spina bifida is to take folic acid supplements before and during pregnancy.
Folic acid recommendations
You should take a 400 microgram folic acid tablet daily while trying to get pregnant and till you're 12 weeks pregnant.
If you did not take folic acid before you conceived, you should start once you realize you're pregnant.
Folic acid tablets are obtainable from pharmacies and supermarkets, or a GP may be able to prescribe them for you.
You should also eat foods that have folate (the natural form of folic acid), such as broccoli, spinach and chickpeas.
Recommendations for women at greater risk of spina bifida
Women thought to be at greater risk of having a child with spina bifida need to be prescribed a higher (5 milligram) dose of folic acid by a Doctor.
Women at greater risk include those:
- With a family medical history of neural tube defects.
- With a partner with a family medical history of neural tube defects.
- Who had a former pregnancy affected by a neural tube defect.
- With diabetes.
A Doctor can advise you further about this.
If you're taking medicine to treat epilepsy, you should ask your Doctor for advice. You may also need to take a higher dose of folic acid.
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