Lower spina bifida in babies whose mothers took folic acid

Health Ministry says folic acid supplementation recommended for women intending or liable to become pregnant.

By JUDY SIEGEL-ITZKOVICH
baby in cot 311 (photo credit: Illustrative photo)
baby in cot 311
(photo credit: Illustrative photo)
A Health Ministry recommendation 10 years ago to encourage women of childbearing age to take folic acid supplements has brought a significant reduction in the prevalence of serious neural tube disorders such as spina bifida.
Based on the Latin words for “split spine,” spina bifida is a developmental birth defect caused by the incomplete closure of the embryonic neural tube. Some vertebrae overlying the spinal cord are not fully formed and remain unfused. If the opening is large enough, it allows part of the spinal cord to push through the opening in the bones, sometimes with a fluid-filled sac surrounding the spinal cord. It often results in paralysis from the waist down.
Other neural tube defects include anencephaly, a condition in which the portion of the neural tube that will become the cerebrum does not close, and encephalocele, which results when other parts of the brain remain unfused.
Spina bifida can be sealed through surgery following birth, but this does not restore normal function to the affected part of the spinal cord. Intrauterine surgery for spina bifida has also been performed, and the safety and efficacy of this procedure is currently being studied.
There is no one cause of spina bifida or any known way to prevent it completely, but folic acid (folate) supplementation – either as a pill or as part of a nutritional diet that includes whole grains, fortified breakfast cereals, dried beans, leaf vegetables and fruits – is strongly recommended.
In a report released for publication on Monday, the ministry said folic acid supplementation was recommended for women intending (or liable) to become pregnant, during the three months before conception and during the first three months of pregnancy, when the organs in the fetus form.
Neural tube defects in Israel declined from 14.8 cases per 10,000 live births in 1999- 2001 to 9.2 in 2007-2009. The largest decline was with spina bifida – 52 percent. The drop in the prevalence of spina bifida among Muslims was an impressive 63.5% during the decade.
Seventy-eight babies were born with spina bifida in 1999, compared to 41 in 2009, with the rate declining from 6.5 per 10,000 live births to 2.5.
The rate among Jews declined from 4.3 per 10,000 to 2.1 and among non-Beduin Muslims from 9.6 to 3.8; the Beduin rate declined from 15.8 to only 4 during that period.
It was more difficult to know how folate supplementation affected the prevalence of anencephaly, as many of these fetuses are detected during early pregnancy using ultrasound and then aborted or were naturally miscarried; spina bifida fetuses are less likely to be miscarried.
The ministry said it is working toward the mandatory fortification with folate of various foods to raise the rate of women of childbearing age consuming it automatically as part of their diet.
Folate fortification of enriched grain products has been mandatory in the US since 1998. The US Food and Drug Administration and other regulatory agencies recommend at least 0.4 mg/day of folic acid from at least three months before conception until the end of the third month of pregnancy. Women who have already had a baby with spina bifida or other type of neural tube defect should take a higher dose of 4 to 5 mg/day.