Take folic acid to prevent spina bifida

Authors: Qi Yan, Zhong Ruiqing, Gao Hongyan, Xie Haixia; Chief Judge: Zhai Hua

Unit: Shanghai Yangzhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center)

This popular science work is one of the popular science materials in the series "Don't be afraid of spinal cord injuries, there are ways to prevent and rehabilitate them"

October 25th of every year is World Spina Bifida and Hydrocephalus Day, abbreviated as World Spina Bifida Day, which is initiated by the international organization "World Association of Spina Bifida and Hydrocephalus". Its purpose is to make the public aware of this common congenital birth defect , pay attention to the emergency rescue of children with spina bifida and hydrocephalus , and improve the living conditions of these disabled adults.

01 What is spina bifida?

Spina bifida is a congenital neural tube defect caused by the failure of the central neural tube to fuse properly in the early stages of embryonic development. It is also one of the most common structural malformations in humans. The incidence of spina bifida in live births worldwide is 0.047%. There is no accurate epidemiological survey data on spina bifida in China. The incidence of spina bifida varies depending on the use of folic acid, region, race and ethnicity.

02 How is spina bifida classified?

Spina bifida is divided into occult spina bifida and manifest spina bifida (mainly including myelomeningocele and myelomeningocele ) according to the severity of symptoms.

03 What causes spina bifida?

The cause of spina bifida is still not very clear. It is generally believed that the main causative factors include folic acid deficiency or metabolic abnormalities, viral infection, drugs, diabetes, obesity, genetic or gene mutations, etc.

04 How to prevent spina bifida?

Up to 70% of spina bifida birth defects can be avoided by guiding the pregnancy process, such as controlling blood sugar, controlling weight, enhancing immunity, minimizing or avoiding the use of medications that interfere with folic acid absorption, and supplementing with appropriate amounts of folic acid before pregnancy and during the perinatal period.

05 What is folic acid?

Folic acid, also known as pteroylglutamic acid, is a water-soluble B vitamin extracted and purified from spinach leaves by Mitchell (H.K. Mitchell, 1941) and named folic acid.

06 How should folic acid be supplemented?

Food supplements

For dietary supplements, you can eat more foods rich in folic acid, such as animal liver, vegetables (spinach, rapeseed, broccoli, etc.), beans, nuts, and fruits (strawberries, oranges, etc.). When supplementing with food, you should pay attention to the characteristics of folic acid. Folic acid is unstable when exposed to light and heat and easily loses its activity. For example, vegetables lose 50% to 70% of folic acid after being stored for 2 to 3 days; cooking methods such as soup will cause the loss of 50% to 95% of folic acid in food. Therefore, you should change some cooking habits to reduce the loss of folic acid.

Oral folic acid

For the special group of pregnant women, if they only rely on natural food to supplement folic acid, it may not be enough, so they need to take additional folic acid tablets.

Folic acid is a successful strategy for modern public health to prevent spina bifida and other neural tube defects. A study showed that the incidence of spina bifida in live births in areas where folic acid is mandatory is 33.86/100,000, while the incidence in areas where folic acid is voluntary is as high as 48.35/100,000; if live births, stillbirths and terminations of pregnancy are included, the incidence of spina bifida in areas where folic acid is mandatory is 35.22/100,000, while the incidence in areas where folic acid is voluntary is 52.29/100,000.

Women who are planning to get pregnant but do not have high-risk factors

Start taking folic acid 0.4mg/day three months before pregnancy, increase to 0.4-0.8mg/day after pregnancy is confirmed, and maintain throughout the pregnancy. The best time to take folic acid is in the early morning, half an hour to one hour after breakfast! In case of unexpected pregnancy, start taking folic acid after pregnancy is confirmed. It is more beneficial for eugenics for fathers to take folic acid before pregnancy!

Women who are planning to get pregnant and have high-risk factors

Different methods of supplementation are recommended

Modern rehabilitation management for spina bifida is extensive and multidisciplinary, requiring collaborative management by multiple teams including medication, surgery, and rehabilitation to provide necessary lifelong care for patients with spina bifida.

(Some pictures in this article are from the Internet)

References:

1. Multidisciplinary expert consensus on rational folic acid supplementation in Chinese clinics[J]. Medical Herald, 2021, 40(01): 1-19.

2. Xiu Bo. Expert consensus on the diagnosis and treatment of spina bifida[J]. Chinese Journal of Reparative and Reconstructive Surgery, 2021, 35(11): 1361-1367.

3. Joseph David B, Baum Michelle A, Tanaka Stacy T, Frimberger Dominic C, Misseri Rosalia, Khavari Rose, Baillie Sharon, Yerkes Elizabeth B, Wood Hadley. Urologic guidelines for the care and management of people with spina bifida.[J]. Journal of pediatric rehabilitation medicine, 2020;13(4):479-489.

4. Conklin MJ, Kishan S, Nanayakkara CB, Rosenfeld SR. Orthopedic guidelines for the care of people with spina bifida. J Pediatr Rehabil Med. 2020;13(4):629-635.