A healthy living blog from Marshfield Clinic

Spina bifida and pregnancy: What to know if you’re expecting

Woman holding a baby - Spina bifida awareness

Taking a folic acid supplement is an important step for women to take to help prevent spina bifida.

Spina bifida can have severe or fatal consequences for babies, but a little preventive action can go a long way.

Spina bifida takes root in the very early stages of pregnancy when the developing baby’s neural tube, which eventually becomes the brain and spinal cord, does not entirely close. With spina bifida, varying degrees of severity can occur.

“Spina bifida occulta is the least worrisome, and the only sign may be a tuft of hair over the infant’s lower back. In this case, the neural tube is intact with normal functioning,” said Dr. Stephanie Sublett, a Marshfield Clinic OB-GYN. “On the other end of the spectrum, you can have a meningomyelocele, a more severe kind of spina bifida, where the spinal cord and surrounding membranes are exposed. Meningomyelocele can result in permanent lower extremity paralysis for the child.”

If meningomyelocele is identified, a consult with a pediatric neurosurgeon is commonly the next step for pregnant women.

What’s the prognosis?

The gravest outcome of spina bifida is death of the baby, but more mild forms of the disease may present symptoms like bowel and bladder problems, lower-leg paralysis, and increased fluid and pressure in the head. Spina bifida also can negatively impact intelligence level.

“It’s a wide spectrum, from things being pretty much completely normal to those severe cases,” Sublett said.

Detection

“We conduct routine ultrasounds for women who are 18-22 weeks pregnant, and we look at all the levels of the spine to make sure there are no abnormalities,” Sublett said.

A blood test also is available, which indicates whether a pregnancy is at an elevated risk for spina bifida. Women who have had a prior pregnancy in which the child had a neural tube defect are at greater risk of seeing neural tube defects occur in future pregnancies. Taking anti-seizure medications also increases risk for spina bifida.

Prevention

Taking a daily folic acid supplement is an important action women can take to help prevent neural tube defects, Sublett said. She recommends women in the first three months of pregnancy and women wanting to become pregnant take folic acid, which is contained in most prenatal vitamins.

The recommended dose of folic acid for women is 0.4 milligrams (400 micrograms) daily. Women who have had a previous child affected by a neural tube defect or are taking anti-seizure medications should take 4 milligrams of folic acid daily, which is ten times the amount normally recommended.

“Women with known spina bifida risk factors should seek obstetric care as soon as they are pregnant,” Sublett said.

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