Introduction
One of the first parts of the body to expand is the middle nervous system.
The neural tube, from which the spinal cord and brain develop, is fashioned
inside the first 25 days of pregnancy. Spina bifida is sourced by the
failure of the neural tube to expand correctly, therefore the term 'neural
tube defects'. Related defects are anencephaly (the absence of a brain) and
encephalocele (a malformation of the brain and skull). Why does the neural
tube develop incorrectly? The reasons are not yet known and are thought to
be connected with both genetic and ecological factors. If a couple has had
one affected child, the risk of recurrence in another pregnancy is
calculated at about 1 in 35.
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What has research shown?
Research on the adding up of folic acid (vitamin B9) to the diet has shown
decisively that women who have had a pregnancy affected by neural tube
defect can reduce their odds of having a second affected pregnancy - by a
dramatic 72%.
In April 1983, the Medical Research Council started a clinical trial of
folic acid and other vitamin supplements in the avoidance of neural tube
defects. The trial was conducted at 33 centers in seven countries and the
consequences were proclaimed in July 1991. The dose given to women taking
folic acid by itself was 4mg a day. The women employed to the trial and each
child born during the trial was checked for possible adverse effects. The
infants sustained to be monitored until their third birthday. As yet, no ill
effects sourced by folic acid supplements have been reported in either the
mothers or their babies.
What does this mean in practice?
These consequences show that, by taking a daily folic acid supplement, a
woman can diminish the risk of having a new pregnancy affected by neural
tube defect. Women considered to be at higher jeopardy of having a neural
tube defect pregnancy comprise those who have had a beforehand affected
pregnancy, those who have an NTD themselves and those who have a family past
of NTD or whose partner has a family history of NTD. Women in these superior
risk groups ought to take a daily 5mg tablet of folic acid for at least one
month before conception and then all the way through the first 12 weeks of
pregnancy. These 5mg tablets have to be attained on recommendation from a
doctor.
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At present, the only tablets obtainable on prescription in the United
Kingdom contain 5mg of folic acid. Some doubts linger that this dosage may
be larger than necessary for preventative effect and it is 1mg larger than
the quantity used in the Medical Research Council trial. The Chief Medical
Officer says a 4mg tablet will restore 5mg as soon as this dosage is
obtainable. Women who have not been acknowledged as being in a high-risk
group may also benefit from taking folic acid tablets. These are accessible
in lower dosage 0.4mg tablets, found among the vitamin displays in
pharmacies and health food shops. Once more, these should be taken for at
least one month prior to beginning and then until the end of the first 12
weeks of pregnancy. Women in families where there has been spina bifida in
other relatives might desire to obtain genetic therapy. In these cases, they
ought to ask their doctors to submit them to a genetic counselor. ASBAH has
an information sheet on this topic which is accessible free of charge.
A healthy diet can help
Many studies have exposed that diet is a causal issue to the well-being of
the fetus and it would seem prudent for women who are planning to turn out
to be pregnant to make sure that their diet is resistant with items in which
folic acid naturally takes place. These comprise barley, baked beans,
brewer's yeast, endive, chickpeas, green leafy vegetables, lentils, orange
juice, oranges, peas, rice, Soya beans, split peas, sprouts, wheat and wheat
germ. Vegetables ought to be evenly cooked as over-boiling wipes out their
vitamin content. Advice to eat liver ought to not be heeded: liver contains
concentrations of vitamin A which, when added to vitamin A intake from other
foods, can harm the unborn baby. Some matters might have an effect on the
absorption of folic acid so, if one is taking any medication, they need to
ensure this with their doctor.
If they are on anti-convulsant medication, they should consult their
neurologist before taking folic acid, as folic acid and some anti-convulsants
can be antagonists (i.e. work against each other).
Folic acid supplements taken before conception can reduce the risk of neural
tube defects recurring. They will not however, guarantee the elimination of
neural tube defects, such as spina bifida. ASBAH remains committed to
supporting research into the causes of neural tube defects, their effects on
people's life and the continuing support of the many thousands of people
with spina bifida, and their families.
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