Diagnosis and management of neural-tube defects today

Article Abstract:

Neural tube defects result from incomplete closure of the neural tube, the structure in fetal life that will grow to become the cranium, surrounding the brain, and vertebral column, surrounding the spinal cord. Impairment of motor or intellectual function occurs if portions of the central nervous system protrude through these openings; presently, the incidence of anencephaly (failure of the brain to develop) or meningomyelocele (herniation of the spinal cord and surrounding membranes through the vertebral column) is 3 to 4 per 10,000 live births. The incidence of such defects may be reduced if pregnant women take vitamins containing folate during early pregnancy. Also, as an article in the March 7, 1991 issue of The New England Journal of Medicine reports, certain antiepileptic drugs may be associated with a higher incidence of neural tube defects. Affected fetuses are often identified in prenatal testing by measuring the levels of maternal serum alpha-fetoprotein or by ultrasonography. Ultrasonography has become increasingly accurate in recent years for diagnosing this disorder, although its accuracy varies considerably among medical centers. In skilled hands, the method can allow clinicians to estimate the probable degree of impairment. The outcome can be improved by delivery via planned cesarean section before the onset of labor, as shown in one report in the March 7, 1991 issue of The New England Journal of Medicine. In this study, infants who did not undergo labor had a lower risk of severe paralysis and better motor function than infants who experienced labor (even if they were subsequently delivered via cesarean section). The study was carried out retrospectively, and could be criticized by some for this reason; however, it would be difficult to conduct a randomized, controlled trial of such a subject. Overall, progress can be seen in reducing the number of infants born with neural tube defects, in prenatal diagnosis, and in minimizing the extent of impairment. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Abnormalities, Diagnosis, Myelomeningocele, Meningomyelocele, editorial

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Reduction in neural-tube defects after folic acid fortification in Canada

Article Abstract:

The changes in the prevalence of neural-tube defects in Canada before and after food fortification with folic acid is used are assessed. The results have shown that food fortification with folic acid is associated with the reduction in the rate of neural-tube defects in Canada and the decrease is very high in the areas in which the baseline is very high.

Diet therapy, Clinical report

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Folic acid and the prevention of neural-tube defects

Article Abstract:

All flour and other grain products sold in the US should be fortified with folic acid and all women who plan on getting pregnant should take folic acid supplements. These two measures could prevent 85% of all neural tube defects in newborn babies. Neural tube defects are defects in the spine and include spina bifida, meningomyelocele, and encephalocele.

Nutritional aspects

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