The neural tube is the structure in a developing embryo that gives rise to the baby’s brain, spinal cord, and the tissues that surround them. Spina bifida is a type of birth defect that happens when the spine and spinal cord don’t form properly.
Spina bifida is a condition in which a portion of the neural tube fails to develop or close completely, leading to defects in the spinal cord and the spine’s bones. Normally, the neural tube forms early in pregnancy and closes by the 28th day after conception.
Depending on the type, size, location, and complications of the defect, spina bifida can range in severity from mild to severe. When necessary, early treatment for spina bifida involves surgery, though this doesn’t always completely solve the issue.
Types
Spina bifida can manifest in a variety of ways, including the uncommon meningocele type (pronounced “muh-NING-go-seel”), myelomeningocele, and spina bifida occulta.
Spina bifida occulta
The mildest and most prevalent form of spina bifida, which is referred to as “occulta” (Latin for hidden), causes a small separation or gap in one or more vertebrae in the spine. Many people with spina bifida occulta are unaware that they have the condition unless it is discovered during an imaging test used for another purpose.
Myelomeningocele
The most severe type of myelomeningocele, also known as open spina bifida, occurs when the membranes and spinal nerves push through the opening in the spinal canal at birth, forming a sac on the baby’s back and typically exposing tissues and nerves. This makes the baby vulnerable to life-threatening infections and may also result in paralysis, bladder and bowel dysfunction, and paralysis.
Symptoms
Spina bifida signs and symptoms differ depending on the type, degree, and individual.
- Spina bifida occulta.Because the spinal nerves aren’t affected, there usually aren’t any signs or symptoms; however, occasionally you can see signs on the newborn’s skin above the spinal defect, such as an abnormal tuft of hair, a small dimple, or a birthmark.
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Myelomeningocele.Spina bifida of this serious type:
- Along a number of the lower or middle back vertebrae, the spinal canal is still accessible.
- At birth, the spinal cord or nerves as well as the membranes protrude, forming a sac.
- Although occasionally skin covers the sac, tissues and nerves are typically exposed.
Causes
Spina bifida, which is thought to be caused by a combination of genetic, nutritional, and environmental risk factors, including a family history of neural tube defects and a folate (vitamin B-9) deficiency, is not fully understood by medical professionals.
Risk factors
Although doctors and researchers are unsure of the exact cause of spina bifida, they have identified some risk factors: White and Hispanic ethnic groups are more likely to be affected than other ethnic groups, and females are affected more frequently than males.
- Folate deficiency.A folate deficiency increases the risk of spina bifida and other neural tube defects. Folate, the natural form of vitamin B-9, is essential for the growth of a healthy baby. Folic acid, the synthetic form of the vitamin that can be found in supplements and fortified foods.
- Family history of neural tube defects.A woman who was born with a neural tube defect has a greater chance of giving birth to a child with spina bifida, but most babies with spina bifida are born to parents with no known family history of the condition. Couples who have had one baby with a neural tube defect have a slightly higher chance of having another baby with the same defect, and that risk increases if two previous children have been affected by the condition.
- Some medications.For instance, anti-seizure drugs like valproic acid (Depakene) appear to cause neural tube defects when taken during pregnancy. This may be because they impair the body’s utilization of folic acid and folate.
- Diabetes.Spina bifida is more likely to be present in a child born to diabetic mothers whose blood sugar is not properly managed.
- Obesity.Obesity before becoming pregnant raises the risk of birth defects of the neural tube, such as spina bifida.
- Increased body temperature.According to some research, hyperthermia, or an increase in body temperature, may increase the risk of spina bifida during the first few weeks of pregnancy. Additionally, a fever or using a sauna or hot tub has been linked to an elevated risk of spina bifida.
Complications
Spina bifida may have few symptoms or only slight physical impairments, but more severe cases can result in more profound physical impairments.
- A defect in the neural tube’s size and location
- No matter if the afflicted area has skin
- what spinal nerves emerge from the spinal cord’s affected region
Despite the fact that not all children with spina bifida experience each of these complications, they are all treatable and the list of potential complications is not exhaustive.
- Walking and mobility problems.Whether a child can walk usually depends on where the defect is, its size, and the care received before and after birth. Spina bifida is a condition in which the nerves that control the leg muscles do not function properly below the area of the defect.
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Orthopedic complications.Depending on where the defect is located, children with myelomeningocele may experience a range of orthopedic issues, including:
- Curved spine (scoliosis)
- Abnormal growth
- Dislocation of the hip
- Bone and joint deformities
- Muscle contractures
- Bowel and bladder problems.Myelomeningocele affects the nerves that supply the bladder and bowels, which originate from the lowest level of the spinal cord and typically do not function properly in children with the condition.
- Accumulation of fluid in the brain (hydrocephalus).Myelomeningocele babies frequently develop hydrocephalus, a condition where fluid builds up in the brain.
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Shunt malfunction.Warning signs may vary, but some of them include: A shunt that isn’t working may have been implanted in the brain to treat hydrocephalus, but it may stop working or become infected.
- Headaches
- Vomiting
- Sleepiness
- Irritability
- The shunt may swell or become redder.
- Confusion
- A fixed downward gaze causes changes in the eyes.
- Trouble feeding
- Seizures
- Chiari malformation type II.The brainstem, or the lowest portion of the brain above the spinal cord, is elongated and positioned lower than usual in children with the myelomeningocele type of spina bifida, which can cause issues with breathing and swallowing. Rarely, compression on this area of the brain occurs, necessitating surgery to release the pressure.
- Infection in the tissues surrounding the brain (meningitis).Meningitis, a potentially fatal infection in the tissues surrounding the brain, may occur in some babies with myelomeningocele and may result in brain damage.
- Tethered spinal cord.Surgery can lessen the severity of the disability caused by a tethered spinal cord, which develops as the child grows and occurs when the spinal nerves bind to the surgical scar where the defect was repaired.
- Sleep-disordered breathing.Assessment for a sleep disorder in those with myelomeningocele helps detect sleep-disordered breathing, such as sleep apnea, which calls for treatment to enhance health and quality of life. Both children and adults with spina bifida, particularly myelomeningocele, may have sleep apnea or other sleep disorders.
- Skin problems.Children with spina bifida are more likely to experience wound complications while wearing casts because they can’t feel when they develop sores or blisters, which can develop into deep wounds or difficult-to-treat foot infections.
- Latex allergy.It’s best to use latex-free gloves and equipment at delivery time and when caring for a child with spina bifida because children with spina bifida have a higher risk of developing a latex allergy, an allergic reaction to natural rubber or latex products, which can result in rash, sneezing, itching, watery eyes, and a runny nose in addition to potentially life-threatening anaphylaxis.
- Other complications.Children with myelomeningocele may develop learning disabilities, including issues paying attention and difficulty learning reading and math, while children with spina bifida may experience additional issues as they age, such as GI disorders, depression, and recurrent urinary tract infections.
Prevention
Spina bifida and other neural tube defects are significantly decreased by supplementing with folic acid beginning at least one month before conception and continuing through the first trimester of pregnancy.
Get folic acid first
Due to the fact that many women don’t find out they are pregnant until the early weeks of pregnancy, experts advise that all women of childbearing age take a daily supplement of 400 micrograms (mcg) of folic acid.
400 mcg of folic acid is added to a number of foods, including:
- Enriched bread
- Pasta
- Rice
- Some breakfast cereals
The natural form of folic acid present in foods is known as folate, and it may be listed as such on food packaging.
Planning pregnancy
Get 400 to 800 mcg of folic acid per day if you’re an adult woman planning a pregnancy or think you might get pregnant.
Vitamin supplements are required to prevent spina bifida and may also help lower the risk of other birth defects, such as cleft lip, cleft palate, and some congenital heart defects because your body does not absorb folate as easily as it does synthetic folic acid and most people do not get the recommended amount of folate through diet alone.
Additionally, it is advisable to consume a balanced diet that includes foods high in folate or enriched with folic acid. This vitamin is naturally found in a variety of foods, such as:
- Beans and peas
- Citrus fruits and juices
- Egg yolks
- Milk
- Avocados
- Broccoli and spinach are examples of dark green vegetables.
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