NEURAL TUBE DEFECT

Neural tube defects (also called NTDs) are birth defects of the brain and spinal cord. Birth

defects are health conditions that are present at birth. They change the shape or function of

one or more parts of the body. Birth defects can cause problems in overall health, how the

body develops or how the body works.

A baby’s neural tube normally starts out as a tiny, flat ribbon that turns into a tube by the end

of the first month of pregnancy. If the tube doesn’t close completely, an NTD can happen.

NTDs can cause serious problems for babies, including death.

NTDs happen in about 3,000 pregnancies each year in the United States. Hispanic women are

more likely than non-Hispanic women to have a baby with an NTD.

The two most common NTDs are spina bifida and anencephaly. Spina bifida affects about

1,500 babies a year in the United States. If your baby has spina bifida, the tiny bones of the

spine don’t close completely, and part of the spinal cord pokes through the spine. Children

with spina bifida may have paralyzed legs (not able to move) and problems controlling their

bladder and bowel (going to the bathroom). Milder forms of spina bifida may cause fewer

problems for children.

Anencephaly is one of the most severe NTDs. It affects about 1,000 babies each year in the

United States. Anencephaly is caused when the upper part of the neural tube that forms the

brain doesn’t close completely. Babies with this condition are missing major parts of the

brain, skull and scalp. They do not survive long after birth, usually for just a few hours. Girls

are 3 times more likely than boys to have anencephaly.

Taking folic acid before and during early pregnancy can help prevent NTDs in your baby.

Folic acid is a B vitamin that every cell in your body needs for normal growth and

development.

What causes NTDs?

We’re not exactly sure what causes NTDs. Experts think some may be caused by genetics.

This means an NTD can be passed from parents to children through genes. Genes are part of

your body’s cells that stores instructions for the way your body grows, looks and works.

NTDs also may be caused by things in your environment. Your environment is all the things

you come in contact with that affect your everyday life, including things like where you live,

where you work, the kinds of foods you eat and how you like to spend your time. Some

things in your environment can be harmful to a pregnancy, like certain drugs, cigarette

smoke, air pollution and lead.

Are you at risk for having a baby with an NTD?

Any woman can have a baby with an NTD. But there are things that may make you more

likely than other women to have a baby with an NTD. These are called risk factors.

If you have these risk factors, you’re at high-risk for NTDs:

 You’ve had a baby with an NTD. If you’ve had a baby with an NTD, there’s a 2- to

3-percent chance of having a baby with an NTD in another pregnancy. To find out about

your risk for NTDs, talk to a genetic counselor. This is someone who is trained to help

you understand about genes, birth defects and other medical conditions that run in

families, and how they can affect your health and your baby’s health.

 You or your partner has an NTD, your partner has a child with an NTD or

someone in either of your families has an NTD. This means you have a family
 history of NTDs. To find out about health conditions like NTD that may run in your

family, use the March of Dimes Family Health History Form. Fill it out and share it

with your health care provider or genetic counselor.

Other risk factors for NTDs include:

 You take certain anti-seizure medicines. If you take medicine to prevent seizures,

talk to your health care provider before you get pregnant about how the medicine may

affect your pregnancy.

 You’re obese. Some studies show that being obese increases your risk for having a

baby with an NTD. If you’re obese, you have an excess amount of body fat and your

body mass index (BMI) is 30 or higher. To find out your BMI, go to cdc.gov/bmi. Talk to

your provider about getting to a healthy weight before pregnancy.

 You have diabetes. Diabetes is a medical condition in which your body has too much

sugar (called glucose) in your blood. This can damage organs in your body, including

blood vessels, nerves, eyes and kidneys. If your diabetes is uncontrolled, you may be at

increased risk for having a baby with an NTD. You can help control diabetes by eating

healthy foods and being active every day.

 You use opioids in the first 2 months of pregnancy. Opioids are highly addictive

drugs. Your provider may prescribe an opioid to you as a painkiller if you’ve been injured

or had surgery. Common prescription opioids include codeine, hydrocodone and

oxycodone. These often are sold and used illegally. If you take any opioid during

pregnancy, it can cause serious problems for your baby, like premature birth and drug

withdrawal called neonatal abstinence syndrome (also called NAS). If you’re pregnant

and taking any drug or medicine that may be an opioid, tell your health care provider

right away.
 You have a high body temperature early in pregnancy. This may be caused by a

fever or by spending a lot of time in a hot tub or sauna. If you’re pregnant, stay out of hot

tubs and saunas. If you do use them, limit the time to less than 10 minutes.

How can you help prevent NTDs in your baby?

Taking folic acid before and during early pregnancy can help prevent NTDs in your baby.

NTDs happen in the first month of pregnancy, before you may know you’re pregnant. This is

why it’s important to have enough folic acid in your body before you get pregnant.

Most women

To help prevent NTDs in your baby, before pregnancy take a vitamin supplement with 400

mcg of folic acid every day. A supplement is a product you take to make up for certain

nutrients that you don’t get enough of in the foods you eat. Start taking 400 mcg of folic acid

each day at least 1 month before pregnancy through the first 12 weeks of pregnancy. Your

folic acid supplement can be:

 A multivitamin. This is a pill that contains many vitamins and other nutrients that

help your body stay healthy.

 A prenatal vitamin. This is a multivitamin that has nutrients you need during

pregnancy. Your health care provider may give you a prescription for prenatal vitamins,

or you can get them over the counter without a prescription.

 A supplement that contains just folic acid

Take a vitamin supplement with 400 mcg of folic acid each day, even if you’re not trying to

get pregnant.

Women at high risk for NTDs

If you’re at high risk for having a baby with an NTD, take 4,000 mcg of folic acid each day to

help prevent an NTD. Start taking 4,000 mcg 3 months before you get pregnant through 12

weeks of pregnancy. You’re at high risk if:

 You’ve had a pregnancy with an NTD in the past.

 You or your partner has an NTD.

 Your partner has a child with an NTD.

Studies show that taking 4,000 mcg of folic acid before and during early pregnancy can help

reduce your risk of having another baby with an NTD by about 70 percent. Ask your provider

how to safely get this much folic acid. It’s not safe to take several multivitamins or prenatal

vitamins because you can get too much of other nutrients, which may be harmful to your

health. Your provider can help you figure out the best and safest way for you to get the right

amount of folic acid.

Can you get folic acid from food?

Yes! You can get folic acid from foods that are fortified with folic acid. Fortified means a

food has folic acid added to it. Check the product label to see how much folic acid you get in

each serving. Look for the word “fortified” or “enriched” on labels on foods like:  

 Bread

 Breakfast cereal

 Cornmeal

 Flour

 Pasta
 Products made from a kind of flour called corn masa, like tortillas, tortilla chips, taco

shells, tamales and pupusas

 White rice

Some fruits and vegetables are good sources of folic acid. When folic acid is naturally in a

food, it’s called folate. Foods that are good sources of folate are:

 Beans, like lentils, pinto beans and black beans

 Leafy green vegetables, like spinach and Romaine lettuce

 Asparagus

 Broccoli

 Peanuts (But don’t eat them if you have a peanut allergy.)

 Citrus fruits, like oranges and grapefruit

 Orange juice (100 percent juice is best. This means one serving of juice is equal to

one serving of fruit.)

It’s hard to get all the folic acid you need from food. Even if you eat foods that have folic

acid in them, take your vitamin supplement each day, too.

 Maternal blood screening (also called a quad screen). It’s called a quad screen

because it measures four substances in your blood. The test is done at 15 to 22 weeks of

pregnancy.

 Ultrasound. This test uses sound waves and a computer screen to show a picture of

your baby inside the womb. You usually get an ultrasound at 16 to 20 weeks of

pregnancy.
If a screening test shows an increased risk of NTDs, your provider may recommend a

diagnostic test to find out for sure if your baby has an NTD. Diagnostic tests for NTDs

include:

 Amniocentesis. In this test, your provider takes some amniotic fluid from around your

baby in the uterus (womb) to check for birth defects, like NTDs, in your baby. You can

get this test at 15 to 20 weeks of pregnancy.

 Detailed ultrasound of your baby’s skull and spine

If you find out during pregnancy that your baby has an NTD, talk to your health care provider

to learn more about your baby’s condition and options for birth and treatment. For example:

 You can plan to have your baby in a hospital that specializes in caring for babies with

NTDs. This way your baby can have any necessary surgery or treatment soon after birth.

 You can decide whether to have a vaginal or cesarean birth (also called c-section).

During vaginal birth, the uterus contracts to help push the baby out through the vagina. A

c-section is surgery in which your baby is born through a cut that your doctor makes in

your belly and uterus. In some cases, a c-section may be safer for you and your baby than

vaginal birth.

 If your baby has spina bifida, you can find out about surgery for your baby in the

womb before birth. Surgery to repair spina bifida in the womb before birth is more

effective than surgery after birth.

Prevention

About two-thirds of neural tube defects can be prevented through increasing folate (folic
acid) intake at least a month before pregnancy and during the first 3 months of pregnancy.
Adequate folate levels are critical during the early days of the developing embryo,
particularly the 3rd and 4th week, the period in which neural tube defects occur and when
many women won’t know they are pregnant.

You can increase your folate intake by eating folate-rich foods, including folate-fortified
foods in your daily diet, or by taking a folic acid supplement. Good sources of folate include
green leafy vegetables, fruit (citrus, berries and bananas), legumes and some cereals (bread
and many breakfast cereals now have added folate).

Women who take medicines to control epilepsy, seizures or psychiatric disorders should talk
to their doctor before taking folate because it can interfere with how their medications work.