What causes spina bifida? Folic acid and other risk factors

Spina bifida is a spinal injury in babies. The main cause of spina bifida is a lack of folic acid during pregnancy, although it can also be caused by family history, medicines taken during pregnancy and genetic condition.

Since January 2020, dozens of babies were saved from spina bifida-caused paralysis as a result of surgery in the womb.

This article will go into more detail about what spina bifida and folic acid are, how you might assess the risk factors for spina bifida, and whether you can get compensation if your child has suffered as a result of related medical negligence.

What is spina bifida?

Spina bifida is a medical condition that impacts the development of a baby’s spine early on in a pregnancy. In the first month of pregnancy, a baby’s spine and brain start to develop from the embryonic neural tube. The process of this tube closing is a key early event in your baby’s brain and spinal cord development3.

Spina bifida and the neural tube

The neural tube is what forms your baby’s early brain and spine. The tube begins to close at the spinal cord, and then extends to the brain.

Sometimes, the neural tube is defective, and doesn’t close – leaving a gap in the spine. The neural tube defect causes interference with messages that are passed through nerves in the spinal system, impacting the areas of the body that receive nerve supply from this damaged area of the spine
. The most common form of the disease is known as Spina Bifida Occulta – when one or more vertebrae do not form properly.

What is folic acid?

Folic acid is the man-made version of the vitamin folate (also known as vitamin B9). Folate helps your body make healthy red blood cells5 and is a naturally occurring source in foods such as broccoli, dark green, leafy vegetables, whole grains and beans
.

In pregnancy, folic acid helps your unborn baby’s brain, skull and spinal cord develop properly5. It may prevent up to seven out of ten cases of neural tube defects such as spina bifida1.

Does folic acid deficiency cause spina bifida?

Yes, a lack of folic acid can increase the risk of the developing neural tube problems, including spina bifida. Not having enough folic acid during pregnancy is one of the most important factors that can increase your child’s chances of having with spina bifida.

Most children with spina bifida will require some support with any learning disabilities they may have, as well as possible physical problems, such as reduced lower body strength and incontinence
.

Spina bifida prevention: How do I take folic acid?

When you are pregnant or trying for a baby, it is recommended that you take folic acid until you are 12 weeks pregnant. This helps your baby grow normally and reduces the risk of neural tube defects, including spina bifida and anencephaly (a brain defect)
.

Folic acid comes in liquid or tablet form. For women trying to get pregnant, and during the first 12 weeks of pregnancy5, the usual dose is 4mg a day. However, you may be recommended a higher dose of 5mg a day if there is a higher risk of neural tube defects during your pregnancy.

Is spina bifida hereditary or congenital?

It isn’t clear what exactly causes spina bifida, but a lack of folic acid during pregnancy is said to be the most prominent risk factor. This would suggest that the condition is congenital, but a family history of the illness can also increase the risk.

Other potential risk factors include:

• Having a previous pregnancy affected by a neural tube defect
• If you or your partner have a neural tube defect
• If you have diabetes
• Taking certain medication – taking valproic acid (a seizure preventative) during pregnancy has been connected to an increased likelihood of spina bifida1
• Genetic illnesses – your child may have Patau’s syndrome, Edwards’ syndrome or Down’s syndrome at the same time as spina bifida, although this is rare
• Obesity – your baby may be more likely to have spina bifida if you are overweight
  .

Reducing the risk of spina bifida: Could flour be fortified?

It is estimated that around 1,000 pregnancies in the UK each year are diagnosed with neural tube defects, which can result in long-term disability for the baby

For many years, Shine (and many other charities) have campaigned for the mandatory fortification of flour with folic acid
. The overall aim of this campaign was to help reduce the risk of defects before and during pregnancy by making the availability of folic acid almost universal.

The practice of fortification of folic acid in flour has been adopted by over 60 countries worldwide, including Australia, Canada and the USA. These countries have seen a vast reduction in the rates of neural tube defects – of up to 58%.

Although there are potential risks associated with increased folic acid intake, the proposal seeks to recommend mandatory fortification. It also calls for clear guidance on the use of folic acid supplements .

In September 2021, the UK Government Department of Health and Social Care announced that “folic acid will be added to non-wholemeal wheat flour across the UK” totry to avoid life threatening spinal issues in babies
. It will be compulsory in or after 2022
.

When is Spina Bifida Awareness Month?

Spina Bifida Awareness Month is in October. Every year, the Spina Bifida Association share moving stories that challenge others to rally support for people with spina bifida.

Can you get compensation for spina bifida?

If mistakes were made in care, some people pursue compensation for spina bifida.

If you have any concerns about a spinal injury because of possible mistakes in your maternity care, investigating whether there is a negligence claim can help you to find answers.

If successful, compensation could provide your child with additional resources to ensure their care, aids and equipment and therapy needs are met for life, and a suitably adapted property for them to live in with you.

Our team at Enable Law will work with you to determine what happened and strive for the best possible outcome for you and your family.

If you have any questions about the care you or your child received, we are here to help. Contact us today.

Spina bifida causes: Key questions

Can a blood test detect spina bifida?

Blood tests can help with the diagnosis of spina bifida. Maternal blood tests can be used to determine the risk of a birth defect. An alpha-fetoprotein (AFP) test during pregnancy measures the level of AFP in the mother’s blood. If the levels are higher or lower than normal, it could indicate a higher risk of the baby having a genetic disorder
.

What are the four types of spina bifida?

There are multiple forms of spina bifida. The main four are:

• Myelomeningocele – the most severe form, where the spinal canal stays open along multiple vertebrae.
• Meningocele – where membranes around the spinal cord push out through the spine.
• Spina bifida occulta – the mildest and most common form, where one or more vertebrae do not form correctly1.
• Closed neural tube defects – a varied range of defects where the spine may have fat, bone or membrane malformations.

When does spina bifida occur in pregnancy

Spina bifida occurs in the first four weeks of pregnancy – while the neural tube is developing. It can occur before the woman knows of the pregnancy.