What are neural tube defects?

The incidence of NTDs is around 7-8 per 1000 live births in India.

The most common NTDs are :

• Anencephaly

  Anencephaly is one of the most severe NTDs. Anencephaly is caused when the upper part of the neural tube that forms the brain doesn’t close completely and is characterised by the absence of a major part of the brain, skull and scalp. These babies do not survive long after birth, usually for just a few hours. Girls are 3 times more likely than boys to have anencephaly.

• Encephalocele

  Encephalocele is a protrusion (bulging) of brain tissue and/or its covering membranes through a defect in the skull.

• Spina Bifida

  Spina Bifida is when the vertebrae (bones of the spine) that cover the spinal cord have one or more openings. This causes exposure and/or protrusion of nerve tissue and its coverings. People with spina bifida have various degrees of nerve damage. Children with spina bifida may have paralyzed legs (not able to move) and problems controlling their bladder and bowel (going to the washroom)

Causes:

Neural tube defects are most likely caused by a combination of genetic and environmental factors.

Factors that increase the risk include deficiency of folic acid before and during the first 3 months of pregnancy, the use of certain medicines (for example, some epilepsy medications), maternal diabetes and genetic factors.

Can NTDs be prevented?

Getting enough folic acid while you are pregnant is the best way to prevent a neural tube defect in your baby. In fact, taking folic acid supplements can reduce the risk of neural tube defects in your baby by up to 70%.

NTDs happen in the first month of pregnancy, before you may know you’re pregnant. This is why it’s important to have enough folic acid in your body before you get pregnant.

Folic Acid is also known as folate or vitamin B9 ; it is present in dark green vegetables, some fruits and legumes.

Foods rich in folic acid

Some fruits and vegetables are good sources of folic acid. When folic acid is naturally in a food, it’s called folate. Foods that are good sources of folate are:

• • Beans, like lentils, pinto beans and black beans
• • Leafy green vegetables, like spinach and Romaine lettuce
• • Asparagus
• • Broccoli
• • Peanuts (But don’t eat them if you have a peanut allergy.)
• • Citrus fruits, like oranges and grapefruit
• • Orange juice (100 percent juice)

Your risk for having a baby with an NTD is higher if:

• • You’ve had a baby with an NTD. If you’ve had a baby with an NTD, there’s a 2- to 3-percent chance of having a baby with an NTD in another pregnancy.
• • You or your partner has an NTD, your partner has a child with an NTD or someone in either of your families has an NTD. This means you have a family history of NTDs.

Other risk factors for NTDs include:

• • Taking anti epileptic medicines
• • Obesity
• • Diabetes . If your diabetes is uncontrolled, you may be at increased risk for having a baby with an NTD. Eating healthy foods and being active every day can help you keep your diabetes under control.
• • Using Opiods in the first 2 months of pregnancy
• • A high body temperature in pregnancy. This may be caused by a fever or by spending a lot of time in a hot tub or sauna. If you’re pregnant, stay out of hot tubs and saunas. If you do use them, limit the time to less than 10 minutes

Diagnosis:

NTDs can be diagnosed early in pregnancy by doing a Screening Test using blood test and ultrasound.

During 16-20 weeks of pregnancy, a maternal blood test called Quad Test is done . A biochemical analyse called alpha fetoprotein is measured which gives the risk of NTD.

Ultrasounddone at 11-14 weeks can also detect NTDs esp anencephaly and encephalocoele.

If a screening test shows an increased risk of NTDs, your doctor may recommend a diagnostic test to find out for sure if your baby has an NTD. Diagnostic tests for NTDs include:

Amniocentesis:In this test, your provider takes some amniotic fluid from around your baby in the uterus (womb) to check for birth defects, like NTDs, in your baby. You can get this test at 15 to 20 weeks of pregnancy.

• • Detailed ultrasound of your baby’s skull and spine.
• • BEST - This means one serving of juice is equal to one serving of fruit.

What if the baby has NTD?

If you find out that your baby has an NTD, talk to your doctor to learn more about your baby’s condition and options for birth and treatment. For example:

Have a detailed discussion with the Paediatric Neuro regarding the severity of the condition and what are future aspects of the baby having a normal life .

• • You can plan to have your baby in a hospital that specializes in caring for babies with NTDs. This way your baby can have any necessary surgery or treatment soon after birth.
• • You can decide whether to have a vaginal birth or a Caesarean, also called c-section
• • If your baby has spina bifida, you can find out about surgery for your baby in the womb before birth. Surgery to repair spina bifida in the womb before birth is more effective than surgery after birth.
• • Try and have more information about the Paediatric NeuroSurgeon who will operate on the baby.