Prenatal Education and Spina Bifida

Research has shown that mothers who have some form of prenatal education, and who are cared for by qualified physicians have significantly lower risk pregnancies. Education is a key factor in preventing possibly severe birth defects such as, “spina bifida. ” Each day an average of 11 babies are born with neural tubal disorders or NTD’s like spina bifida, or anencephaly. “Ninety-five percent of neural tube defects occur in women with no history of neural tube affected pregnancies.

” NTD’s can occur early in pregnancy, often before a woman even knows she is pregnant. “In September, 1992, based on randomized control trials and observational studies, the United States Public Health Service published a recommendation, stating that “all women of childbearing age in the United States should consume 0. 4 mg of folic acid daily to reduce the risk of having a pregnancy affected by a neural tube defect. ” (The Spina Bifida Association of America 1).

“Each year, 300,000 to 400,000 infants worldwide are born with spina bifida and anencephaly,” (Oakley S116). If new mothers, and even young women in general, were more educated about how their diet, and actions effect their babies, the number of cases of NTD’s would be greatly diminished. Spina bifida occurs when the spine fails to close properly during the first few weeks of pregnancy. “The central nervous system and spine develop between the 14th and 28th day after conception,” (Bloom 79).

“Spina bifida occurs when there is a failure of development of the boney canal which surrounds the brain and spinal cord. In the spine, the affected vertebrae have a defect posteriorly (at the back) so that a boney ring does not completely surround the spinal cord. This leaves a gap so that, instead of the posterior arm being whole it is divided – that is bifid. The fault may occur in one or more of the vertebrae but it is most common around waist-level,” (Association for Spina Bifida and Hydrocephalus 1).

People diagnosed with spina bifida may experience in some form “varying degrees of paralysis, loss of sensation in the lower limbs, difficulties with bowel and bladder management, hydrocephalus, learning disabilities and latex allergies. ” “Surgery can be performed within 24 hours after birth to minimize the risk of infection to the child,” (Sandler 45) and to help preserve the existing function in the spinal cord. “Because of the paralysis resulting from the damage to the spinal cord, people born with spina bifida may need surgeries and other extensive medical care,” (SBAA).

“In general, the three types of spina bifida (from mild to severe) are: Spina Bifida Occulta: There is an opening in one or two of the vertebrae (bones) of the spinal column without apparent damage to the spinal cord. Meningocele: The meninges, or protective covering around the spinal cord, has pushed out through the opening in the vertebrae in a sac called the “meningocele. ” However, the spinal cord remains intact. This form can be repaired with little or no damage to the nerve pathways. Myelomeningocele: This is the most severe form of spina bifida, in which a portion of the spinal cord itself protrudes through the back.

In some cases, sacs are covered with skin, in others, tissue and nerves are exposed. Generally, people use the terms “spina Bifida” and “myelomeningocele” interchangeably. Approximately 40% of all Americans may have spina bifida occulta, but because they experience little or no symptoms, very few of them ever know they even have it. The other two types of spina bifida, meningocele and myelomeningocele, are known collectively as “spina bifida manifesta,” and occur in approximately one out of every thousand births.

Of these infants born with “spina bifida manifesta,” about 4% have the meningocele form, while about 96% have the myelomeningocele form,” (National Information Center for Children and Youth with Disabilities 1). Occasionally children with spina bifida can experience learning problems. They may have difficulty with basic functions such as, “paying attention, expressing or understanding language, organizing, sequencing and grasping reading and math,” The earlier parents take action and prepare their children, the sooner the child can adjust and be successful in school.

“Students should be in the least restrictive environment and their day to day activities should be as “normal” as possible,” (SBAA). “Although spina bifida is relatively common, until recently most children born with a myelomeningocele died shortly after birth. Now that surgery to drain spinal fluid and protect children against hydrocephalus can be performed, children with myelomeningocele are much more likely to live. Quite often, however, they must have a series of operations throughout their childhood.

Children with myelomeningocele need to learn mobility skills, and often require the aid of crutches, braces or wheelchairs. It is important that all members of the school team and the parents understand the child’s’ physical capabilities and limitations. Physical disabilities like spina bifida can have profound effects on a child’s’ emotional and social development. To promote personal growth, families and teachers, should encourage children, within the limits of safety and health, to be independent and to participate in activities with their non disabled classmates.

(NICHCY). A large percentage (70%-90%) of children born with myelomeningocele spina bifida may also have a condition called hydrocephalus. Hydrocephaly is a condition in which “a watery fluid, known as cerebro-spinal fluid or CSF, is produced constantly inside each of the four spaces or ventricles inside the brain. The CSF normally flows through narrow pathways from one ventricle to the next, then out over the outside of the brain and down the spinal cord.

The CSF is absorbed into the bloodstream and recirculates, and the amount and pressure are normally kept within a fairly narrow range. If the drainage pathways are blocked at any point, the fluid accumulates in the ventricles inside the brain, causing them to swell – resulting in compression of surrounding tissue. In babies and infants, the head will enlarge,” (ASBAH). “The skull bones in babies and young children are not fixed together as they are in later life, and the pressure causes the head to increase in size,” (Bayston 1).

“In older children and adults, the head size cannot increase as the bones which form the skull are completely joined together,” (ASBAH). “Even very small babies can now be made to survive, but their vital functions, normally taken care of during pregnancy by the mother, have to be controlled artificially. Unavoidable rapid changes in blood pressure can cause bleeding in the brain, and the blood from this hemorrhage blocks the sieve-like absorption system leading to post-hemorrhagic hydrocephalus.

Brain hemorrhages in adults (stroke) is similar and can also lead to hydrocephalus in survivors,” (Bayston). “Hydrocephalus is controlled by a surgical procedure called “shunting,” which relieves the fluid buildup in the brain. If a drain (shunt) is not implanted, the pressure buildup can cause brain damage, seizures, or blindness. Hydrocephalus may occur without spina bifida, but the two conditions often occur together,” (NICHCY 1). “Much is said and written about intelligence, and particularly about IQ (intelligence quotient) in people with hydrocephalus.

In fact this is far more complicated, and a good deal less informative, than many believe. The IQ is made up of several components which can be thought of as verbal and non-verbal, or performance-related tests. People with hydrocephalus generally score better on verbal IQ than on performance IQ and this is thought to reflect the distribution of nerve damage in the brain as described above. Certainly during periods of rising CSF pressure, such as in untreated cases or when a shunt is blocked, the effect on performance IQ is more marked.

Generally speaking, people who have had hydrocephalus since birth or childhood have, as a group, a lower average IQ than a comparable group without hydrocephalus, but it is important to realize that there is a wide range in each group, and some people with hydrocephalus have very high scores. ” There are many people diagnosed with hydrocephalus that lead normal lives, however, “the practical implications of these features of hydrocephalus are that there may be subtle problems of co-ordination of hand movements with what the person sees, as well as a degree of clumsiness, which make it difficult to perform certain tasks or do certain jobs.

With regard to learning in the home or to education in school, there may be real problems with concentration and reasoning which require a sympathetic but skilled approach. For instance, it will often be necessary to teach simple every day tasks like getting out of bed, washing one’s face, dressing and going downstairs as separate short items rather than all at once, and to keep them consistent and repetitive. This does not indicate ‘stupidity’ but is caused by damage to the nerves in the brain which normally allow us to learn very quickly how to do a complex series of things.

” “Psychological development in children and adolescents with hydrocephalus may proceed normally, but sometimes the changes associated with puberty (breast development, body hair growth etc) appear much earlier than expected, and the intrusion of psychological aspects of sexual development into a mind which is emotionally still very immature can cause distressing problems,” (Bayston). One of the factors involved in spina bifida is genetics. If a previous pregnancy was affected by spina bifida, there is a higher risk of it happening again.

There is also a greater risk if there is a family history of spina bifida. “All women capable of becoming pregnant are at risk of having a child born with spina bifida. Ninety-five percent of neural tube defects occur in women with no history of neural tube affected pregnancies. ” Though spina bifida can be a potentially life threatening birth defect without many treatment choices, it can be prevented. “Taking 0. 4 mg of folic acid each day prior to becoming pregnant can prevent between 50% and 75% of the cases of spina bifida and other neural tube defects.

Folic acid, a common water-soluble B vitamin, is essential for the functioning of the human body. During periods of rapid growth, such as pregnancy and fetal development, the body’s requirement for this vitamin increases. Starting January 1, 1998, breads and enriched cereal grains will be fortified with folic acid. All U. S. wheat, rice and corn will be fortified at the rate of 140 micrograms per 100 grams of grain, thus providing most people with 100 micrograms of folic acid daily. Many breads, pastas and cereals already are being sold with the nutrient added.

The Food and Drug Administration had ordered the addition of folic acid to all food grains by the start of 1998, largely due to research indicating that only about 25 percent of women of childbearing age regularly consume enough folic acid in the form of a vitamin supplement. SBAA was very active in the movement to urge the FDA to mandate folic acid fortification, knowing its role in reducing the incidence of spina bifida and neural tube defects. SBAA and others recommended fortification at 350mcg/100gm, which would add approximately .

25mg/day to the average diet, thus preventing an estimated 1,000 cases of spina bifida and anencephaly cases annually. The new fortification levels are expected to reduce the number of cases of spina bifida and anencephaly annually by an estimated 22%,” (SBAA). “Only 56 per cent of women aged 15 to 55 understood the important link, when questioned in a MORI poll commissioned by Action Research. Nearly one in five (17 per cent) were completely unaware of the health benefits of folic acid,” (Freeman 9). “By 1997, only 20% of newly pregnant women in the United States were consuming the recommended amount of folic acid.

Low-income women, on average, consume vitamin supplements even less frequently,” (Itikala 3074). “Studies have shown that one factor that increases the risk of having a NTD baby is low folic acid status before conception and during the first few weeks of pregnancy (called the periconceptional period). Timing is important. NTD’s occur early in pregnancy, often before a woman knows she is pregnant. Since half of the pregnancies in the United States are unplanned, women need to take folic acid throughout their reproductive years.

” There are four ways for women to receive sufficient amounts of folic acid in their diet: by eating enriched grain cereal products, vitamin supplements, breakfast cereals fortified with folic acid, and foods that contain folate naturally. The average American diet includes only about half of the recommended level of folic acid,” (SBAA). If women were more educated about the importance of folic acid and essential nutrients in their diet not only during pregnancy, but during child bearing years, fewer children would suffer from spina bifida and it’s possible complications.

Bibliography : Association for Spina Bifida and Hydrocephalus. “What is Spina Bifida? ” Information. 2001. (April 9, 2001). Bayston, Roger. “Hydrocephalus – what is it and what causes it. ” Information. 2001. (April 9, 2001). Bloom, Beth Ann, and Edward L. Seljeskog. Parent’s Guide to Spina Bifida. Minnessota: Minnessota Press, 1990. Freeman, Miller. “Ignorance still on folic acid. ” Chemist & Druggist. 4 November 2000: 9. Itikala, Padmaja. “Periconceptual Intake of Folic Acid Among Low-Income Women. “The Journal of the American Medical Association.

21 June 2000: 3074. National Information Center for Children and Youth with Disabilities. “Spina Bifida. ” 2001. (April 4, 2001). Oakley, Godfrey. “Folic-acid-preventable spina bifida and anecephaly. ” Bulletin of the World Health Organization. March 1998: S116. Sandler, Adrian. Living With Spina Bifida: A Guide for Families and Professionals. North Carolina: Carolina Press, 1997. Spina Bifida Association of America. “Facts About Spina Bifida. ” 2001. (April 4, 2001). Spina Bifida Association of America. “Folic Acid Information. ” 2001. (April 4, 2001)