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The Role of Folic Acid in Preventing Neural Tube Defects

It is common knowledge that pregnant women need to take a prenatal vitamin containing folic acid, and the primary reason for this is to prevent neural tube defects.

Folic acid is a B-vitamin that is required for the production of DNA and essential for the rapid cell division needed to form fetal tissues and organs during pregnancy. If there is an inadequate amount of folic acid, the neural tube, which will later become the spinal cord, brain, and vertebral column, may not form correctly or close completely. When either of these things happen, a neural tube defect occurs. The neural tube (and thus neural tube defects) form very early in pregnancy, usually 4-6 weeks from the first day of the woman’s last menstrual period (or 2-4 weeks after conception); this is often before the woman even knows she is pregnant.

The two most common types of neural tube defects are spina bifida and anencephaly. Anencephaly is a condition where the upper part of the neural tube fails to close, causing the brain to either not develop completely or be completely absent. Pregnancies affected by anencephaly often result in miscarriage or the baby will die soon after birth. Spina bifida occurs when the lower portion of the neural tube does not close, which leads to improper develop of the spinal cord and vertebrae. There will often be a sac of fluid that protrudes through an opening in the back with a portion of the spinal cord also contained in it. There is a wide range of severities, but paralysis of the legs, lack of bowel or bladder control, hydrocephalus, and learning disabilities are all possible results of spina bifida.

Any woman could have a baby with a neural tube defect. However, there are some known risk factors. If you have had a previous pregnancy that was affected by a neural tube defect, your risk increases about 20 times. Women with insulin-dependent diabetes, women who take seizure medication, women who are obese, women who are exposed to high temperatures early in pregnancy (high fevers or hot tub/sauna use), and white or hispanic women (more often than black women) of lower socio-economic status appear to be at higher risk. Regardless of your risk status, all women should take at least 400 micrograms of folic acid daily to reduce your risk. Because the neural tube begins to form before you are aware of your pregnancy, it is a good idea to take folic acid before you are pregnant. If you are at particularly high risk, ask your doctor about taking a much larger dose of folic acid while you are trying to conceive and for the first three months of your pregnancy.

Not all of neural tube defects can be prevented, but 50-70% of them can just by getting adequate amounts of daily folic acid starting BEFORE you are pregnant. You can easily do this by taking a daily multivitamin containing at least 400 micrograms of synthetic folic acid and eating foods fortified with folic acid like cereals and breads. Naturally occurring folate founds in foods like leafy greens is slightly harder for the body to utilize, but still serves as a source for folic acid. It is recommended that ALL women CAPABLE of becoming pregnant consume adequate daily folic acid and not just those planning a pregnancy. If this would occur, the incidence of neural tube defects would be significantly reduced.