Is Spina Bifida a preventable disease

Introduction

Spina bifida is a neural tube defect that affects the central nervous system. Generally, this tube forms during the early pregnancy and closes around the 28th day post-conception (fertilization). This condition is characterized by an open vertebral column with involvement of spinal cord. The common type of spina bifida observed among the infants is myelomeningocele. It is seen to occur in around 1 per 1,000 births globally.

Etiology

The causes of this disorder are heterogeneous. Genetic factors contribute to around 60-70% of the cases.

Additional risk factors include

  • Decreased folate levels
  • Antiepileptic therapy (mothers)
  • Diabetes mellitus
  • Obesity
  • Alcohol use
  • Smoking
  • Maternal infections
  • Exposure to pesticides

Clinical features

The most commonly observed type of spina bifida is myelomeningocele. It is the most severe form of spina bifida. In this condition, fluid sac is protruded out through an opening in the child’s back.

The segment of the nerves and spinal cord within the sac are damaged causing mild to severe disability. This includes difficulty urinating, decreased sensation in the individual legs and trouble moving the legs.

The lack of sensation in the individual legs increases the risk of pressure sores

Diagnosis

This condition is diagnosed either through pregnancy or once the child is born. The following diagnostic tests help identify spina bifida during pregnancy. This includes

  • Alpha-fetoprotein tests
  • Ultrasound
  • Amniocentesis

In some instances, this condition is not diagnosed until the child is born. A hairy skin patch or swelling on the infants back helps clinically diagnose the disease.

The physician might employ diagnostic tests such as MRI, X-ray, or CT scan for a clear interpretation of the condition.

Treatment

Management of this condition requires both surgical and medical therapy

Surgical interventions may be needed for the following:
  • Repair and closure of the lesion
  • Treatment of hydrocephalus
  • Orthopedic issues such as curved back, hip dislocations, foot and ankle deformities

Surgical closure is usually done during the period from birth to 1st month. The child’s back is closed to minimize the risk of infection that can result in meningitis.

Medical therapy is provided by a team of
  • Pediatricians
  • Neurologists
  • Orthopedic surgeons
  • Occupational therapist
  • Urologists
  • Prevention

    1. Folic acid supplements:

    Maternal folic acid supplements can prevent up to 70% of spina bifida cases. A multivitamin supplement containing folate will reduce the risk of spina bifida in women with a previously affected pregnancy.

    Recommended levels of folate for those at risk is 4 mg, whereas those at low risk are advised to take 0.4 mg. This supplement should be started at least one month before conception and continued through the first trimester of pregnancy.

    2. In case you have a prior history of obesity or diabetes make sure it’s under control if you are planning to conceive.
    3. Avoid exposure to hazardous chemicals and other substances

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