Spina bifida literally means “split spine” and happens when a baby is still in the womb and the spinal column does not close all of the way. For this condition to develop, a group of cells that form the brain and the spinal cord of a baby don’t close all the way, so the backbone that protects the spine doesn’t form completely. As a result, these babies might have a dimple or an opening in their skin in the middle or lower part of the back, or in more serious cases the spinal cord (the bundle of nerves that run down the back) and the covering around the spinal cord could stick out of the opening. There is no specific single known cause for this condition, but it is known that this condition can happen in a baby if a pregnant woman doesn’t get enough folic acid during pregnancy. Folic acid (also called folate) is a vitamin needed for the baby’s spine and other parts of the body to develop normally. Other risk factors associated with having a baby with this condition are obese mothers, mothers taking certain medications for epilepsy, mothers with poorly controlled diabetes and those who have a close family history of a baby born with it. This condition can be detected during pregnancy by doing some specific tests. There is a blood test during the 16th to 18th weeks of pregnancy (called alpha-feto protein test). This test can indicate the likelihood of this condition in about 75 to 80 per cent of women who have a foetus with Spina bifida. An ultrasound of the foetus, also called a sonogram, can show signs of spina bifida such as the open spine of the foetus. This is the usual way that most of these pregnancies are detected. In some settings, a test is done where a small amount of the fluid is taken from the mother’s womb through a thin needle, and analysed for indicators of this condition. Some women who find out their baby has spina bifida, after thorough discussion with their doctor, might choose to end their pregnancy. In some higher developed settings, surgery to prevent worsening of the condition can be done when the baby is still in the womb. Women who choose to continue their pregnancy should make sure to deliver their baby in a hospital or centre that has experience treating babies with spina bifida. The type of surgery and any other treatment for this condition depends on the severity of the condition and any other associated complications The most important information for everyone to know, however, is that this debilitating condition can be largely prevented through proper intake of folic acid, which is needed for proper development of the spine and the brain, as mentioned earlier. Many cases of spina bifida can be prevented if women of childbearing age take 0.4 milligrams (400 micrograms) of folic acid every day before pregnancy and continue to take it throughout the first three months. Some women may have to take more folic acid, especially if they are taking certain medications, such as for epilepsy, depression, or if they are at a higher risk of having a baby with this condition. Because most pregnancies are unplanned and many women don’t find out that they’re pregnant until four to five weeks into the pregnancy, and by this time, the baby’s spine and brain structures have already started to develop, it is important to start taking folic acid before becoming pregnant. This provides the best protection for an unborn baby. Good sources of folic acid include eggs, orange juice, and dark green leafy vegetables. Many multivitamins contain the recommended dose of folic acid, too but the synthetic form in pills is actually better absorbed by our bodies. Dr Ian Shyaka , Resident in Plastic surgery, Rwanda Military Hospital, iangashugi@gmail.com
