Neural tube defects

Neural tubedefects are defects of the baby's nervous system and spine arising in the first four weeks of embryonic development. The most common of these are brainlessness, herniated brain and spinal cord. A baby with a cerebral aponeurosis is incapable of living outside the mother's body. Hernias can be open (not covered by skin) or closed (covered by skin).

A baby born with an open medullary hernia must be operated on in the first day. Despite the operation, the child may develop paralysis and deformity of the upper and lower limbs, urinary and faecal incontinence and mental retardation. Among children born with a closed hernia, only 30 per cent are not affected by neurological disorders.

Poland is one of the countries with the highest infant mortality rate due to neural tube defects in Europe. For years, a low intake of folic acid has been linked to the occurrence of neural tube defects. Multicentre scientific studies have shown that folic acid given to women in the pre-conception period and the first 12 weeks of pregnancy reduces the incidence of neural tube defects in the offspring by 70%.

Folic acid

Folic acid (Acidum folicum) is a B vitamin. In the body, it is reduced to its active form, tetrahydrofolic acid, which is involved in the synthesis of purine compounds, pyrimidine compounds, deoxyribonucleic acid, and amino acid metabolism. Folic acid is essential for normal cell division and plays an important role in tissues where cell division is particularly intense (e.g. haematopoietic tissues, foetal tissues, gastrointestinal epithelial cells). Folic acid plays an important role in the myelination of nerve fibres. The daily requirement of an adult for folic acid is approximately 400 μg. This requirement increases up to 2-fold in pregnant and lactating women and in alcohol-dependent persons. In pregnancy, folic acid should be taken at a dose of 400 μg starting at least four weeks before pregnancy and continuing until the 12th week of pregnancy.

Antiepileptic drugs (phenytoin, phenobarbital, primidone), antitubercular drugs, ethanol, oral contraceptives, folic acid antagonists (sulphonamides, methotrexate, trimethoprim, aminopterin, pyrimethamine, sulfasalazine) may lead to folic acid deficiency in the body. During concomitant use of folic acid and antiepileptic drugs, it is necessary to monitor their concentrations due to changes in their metabolism and the possibility of exacerbation of epileptic symptoms.

Folic acid is found in food in the form of folate. It is contained in dark green and orange vegetables (beans, cabbage, asparagus, lettuce, Brussels sprouts, cauliflower, carrots) and fruits such as oranges and bananas. Liver is also a rich source of folic acid, but it is not advisable to consume it in large quantities.

Since long cooking destroys most of the folic acid, it is available in tablets containing only folic acid, as well as in multivitamin preparations.

Folicacid, photo: shutterstock

Primary prevention of neural tube defects programme

The Primary Prevention of Neural Tube Defects Programme has been running in Poland since 1997. Its aim is to popularise the daily intake of 0.4 mg of folic acid by women of childbearing age who are likely to become pregnant in order to prevent neural tube defects in their children.

The programme aims to disseminate knowledge about folic acid and its relationship to neural tube defects in children, its prevention and the correct use of folic acid to all groups of the population. The programme is headed by Prof. Zbigniew Brzeziński, M.D., of the Mother and Child Institute in Warsaw

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Importance of folic acid in the prevention of neural tube defects

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