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The chance that a pregnancy will be affected by a neural tube defect is less than one in 1000. However, there are a number of factors that will increase this risk. The main one is a close family history of neural tube defects. Neural tube defects include spina bifida, anencephaly, occult spinal dysraphism and encephalocele. It does not matter whether the close family history is on the mother’s or father’s side. There is more chance of having a baby with a neural tube defect if you have already had a baby with a neural tube defect, you or your partner have a close relative born with a neural tube defect, you have insulin dependent diabetes (not gestational diabetes), you are obese, or you take certain anti-epileptic medications, especially those containing sodium valproate or valproic acid. About two-thirds of neural tube defects can be prevented if you eat enough folate (folic acid) before and during the first 3 months of pregnancy. Neural tube defects may be diagnosed during the ultrasound scan that is carried out around week 12 of the pregnancy or, more likely, during the anomaly scan that is carried out around weeks 19 to 20.
During the first month of life, an embryo (developing baby) grows a primitive tissue structure called the ‘neural tube’. As the embryo develops, the neural tube begins to change into a more complicated structure of bones, tissue and nerves that will eventually form the spine and nervous system. However, in cases of spina bifida, something goes wrong with the development of the neural tube and the spinal column (the ridge of bone that surrounds and protects the nerves) does not fully close. Spina bifida is a Latin term that means ‘split spine’.
An ultrasound scan is an entirely safe procedure that uses sound waves to create an image of the inside of your body. Most hospitals will offer women at least two ultrasound scans during their pregnancy. The first is usually at around 8 to 14 weeks and is sometimes called the ‘dating scan’ because it can help to determine when the baby is due. This first scan may be able to detect problems with your baby’s spine that could indicate spina bifida if the condition is severe.
The anomaly scan is an ultrasound scan that is carried out around weeks 19 to 20 of your pregnancy. This scan aims to identify any physical problems with your baby. It is usually during this scan that spina bifida is diagnosed.
If tests confirm that your baby has spina bifida, the implications will be fully discussed with you. You will need to consider your options carefully. Your options are to: continue with your pregnancy while getting information and advice so that you are prepared for caring for your baby end your pregnancy. If you are considering ending your pregnancy, you should talk to your doctor or midwife. They will be able to provide you with important information and advice. Your options for ending your pregnancy will depend on how many weeks pregnant you are when you make the decision. If you decide to end your pregnancy, you may wish to talk to a counsellor afterwards. Your doctor or midwife will be able to arrange this for you. Pregnancy, Birth and Baby is available to support you with decision making regarding your pregnancy options. You can call on 1800 882 436.
Folic acid, or ‘folate’ as it is called in its naturally occurring state, is a member of the B complex group of vitamins. It has been well known for a number of years that sufficient folate in the mother’s diet will reduce the chances of her baby having spina bifida by up to 70%. Adequate folate levels are critical during the early days of the developing embryo, particularly the 3rd and 4th week. It is in this period that neural tube defects occur. Because most women do not realise that they are pregnant this early in the pregnancy and because most pregnancies are unplanned, it is important that all women of childbearing age ensure that they are consuming sufficient folate or folic acid. Since 2009, folic acid has been added to all wheat flour for bread making, apart from organic bread, which has seen a 14% decrease in the rate of neural tube defects. For more information see folate and pregnancy. Sources: Australian Institute of Health and Welfare (Neural tube defects in Australia), myDr (Folic acid and your pregnancy), The Centre for Genetics Education (NEURAL TUBE DEFECTS – SPINA BIFIDA AND ANENCEPHALY)
Last reviewed: October 2016
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