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Spina Bifida
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Spina bifida

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WOMEN'S HEALTH

Pregnancy

Spina bifida is one of a class of birth defects, called neural tube defects. These defects involve damage to the spine and spinal cord.

Under normal circumstances, the neural tube forms in the developing baby in the first few weeks of pregnancy and closes by the 28th day after conception. Later, the top of this tube becomes the baby's brain, and the remainder of the tube becomes the baby's spinal cord. In babies with spina bifida, an area along the lower end of the neural tube fails to develop or close properly, causing defects in the spinal cord and in the bones that make up the backbone (vertebrae) . This can also occur in the middle or upper end of the spine, but it's less common.

Spina bifida is one of the more common birth defects. Treatment for spina bifida may involve surgery, but it depends on the severity of the condition.

Signs and symptoms

Spina bifida occurs in three forms, each varying in severity:

  • Spina bifida occulta. The mildest form of the condition — spina bifida occulta — results in a small separation or gap in one or more of the vertebrae of the spine. This can occur in any vertebra but is most common at the base of the back or lower spine. Because the spinal nerves aren't involved, most children with this form of spina bifida have no signs or symptoms and experience no neurologic problems. An abnormal tuft of hair, a collection of fat, a small dimple or a birthmark may be seen on the newborn's skin above the spinal defect and may be the only indication of the condition. In fact, most people who have spina bifida occulta don't even know it, unless the condition is discovered during an X-ray for unrelated reasons.

  • Meningocele. In this rare form of spina bifida, the protective membranes around the spinal cord (meninges) push out through the opening in the vertebrae. Because the spinal cord develops normally, these membranes can be removed by surgery with little or no damage to nerve pathways.

  • Myelomeningocele. Also known as open spina bifida, myelomeningocele is the most severe form of the condition — and the form people usually mean when they use the term spina bifida. In myelomeningocele, the baby's spinal canal remains open along several vertebrae in the lower or middle back. Because of this opening, both the membranes and the spinal cord protrude at birth, forming a sac on the baby's back. In some cases, skin covers the sac. But in other cases, tissues and nerves are exposed, making the baby prone to life-threatening infections. Neurologic impairment below the sac — often including either partial or complete loss of movement (paralysis) — is common. So are bowel and bladder problems, seizures and other medical complications.

Causes

Doctors aren't certain why neural tubes don't develop or close properly in some babies. But there seems to be a combination of genetic and environmental factors that may cause spina bifida. These include:

  • Genetics. Spina bifida seems to run in some families. However, 95 percent of babies with spina bifida are born to parents with no known family history of the condition.

  • Folic acid deficiency. This vitamin is important to the healthy development of a fetus. Lack of folic acid increases the risk of spina bifida and other neural tube defects.

  • Maternal infections. Some researchers believe that a viral infection early in pregnancy may trigger spina bifida.

  • Some medications. Anti-seizure medications, such as valproic acid (Depakene), seem to cause neural tube defects when taken during pregnancy, perhaps because they interfere with the body's ability to use folic acid.

Risk factors

Although doctors and researchers don't know for sure why spina bifida occurs, they have identified a few risk factors:

  • Race. Spina bifida is more common among Hispanics and whites of European descent.

  • Family history of neural tube defects. Couples who've had one child with a neural tube defect have a one in 40 chance of having another baby with the same defect. That risk increases to one in 20 if two previous children have been affected by the condition. In addition, a woman who was born with a neural tube defect, or has a close relative with one, has a greater chance of giving birth to a child with spina bifida. Still, 95 percent of babies with spina bifida are born to parents with no known family history of this condition.

  • Diabetes. The risk of spina bifida increases with diabetes, especially when the mother's blood sugar is elevated early in her pregnancy. Much of this risk is preventable by careful blood sugar control and management.

  • Obesity. Obese women may have more babies with spina bifida because of nutritional deficits from poor eating habits or because they also have diabetes — another known risk factor for neural tube defects.

When to seek medical advice

If you're a woman of childbearing age, talk to your doctor about taking a daily multivitamin containing 400 micrograms (mcg) of the B vitamin folic acid. Up to 70 percent of neural tube defects in the United States, including spina bifida, could be prevented if all women took enough folic acid every day before and during early pregnancy.

If you have known risk factors for spina bifida, talk with your doctor to determine if you should take a larger dose of prescription folic acid, even before a pregnancy begins. Also discuss which prenatal screening tests might be warranted for you.

If your baby is born with myelomeningocele, you'll likely need to consult with a multidisciplinary team of physicians, surgeons and therapists at a center that specializes in spina bifida treatment. Children with myelomeningocele may require ongoing medical attention throughout their lives to monitor their condition and treat complications.

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This information is provided for general medical education purposes only and is not meant to substitute for the independent medical judgment of a physician relative to diagnostic and treatment options of a specific patient's medical condition.
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