New Research into Spina Bifida
This is a fast-moving research area – important new developments are being reported regularly. Some exciting advances over the last three years include:
Spina bifida can be repaired in the fetus, before birth
Surgical repair of spina bifida has been practised in several centres in the USA for the past 15 years. An important recent development was the report, in 2011, of a clinical trial to evaluate the success of this procedure. The Management of Myelomeningocele Study (MOMS) found that fetal surgery brings significant benefits for the newborn child, including a 50% reduction in shunting for hydrocephalus and a significant improvement in spinal neurological function. Against this was a higher rate of premature birth and maternal complications such as uterine splitting at the operation site. While maternal complications may be increased, , these pioneering studies will encourage more widespread implementation of this procedure in the coming years. Read more
Folic acid is being added to the food supply in many countries
We know from the ‘MRC trial’, conducted in the 1980s, that folic acid when taken before conception and in the early weeks of pregnancy can help prevent Spina Bifida. However, despite public health education campaigns in many countries, the prevalence of Neural Tube Defects has not decreased as expected. This is probably because most women start taking folic acid too late for it to be effective. In the USA, mandatory fortification of bread flour with folic acid was introduced in 1998, and since then many other countries including Canada, all of South America, South Africa and, most recently, Australia (2009) have adopted this approach. No European countries have yet to implement food fortification, although many organisations are putting pressure on their governments to follow suit.
Vitamin B12 can provide further protection against Spina Bifida
As well as folic acid, it is very likely that increasing a woman’s intake of vitamin B12 can help reduce the risk of Spina Bifida. This is because vitamin B12 is a key factor in ensuring the proper handling (‘metabolism’) of folates in the cell. Without it, folates become ‘trapped’ and cannot be fully effective. Research by Professor John Scott (Trinity College Dublin) has provided evidence to support this view.
Inositol might offer a new way of preventing Spina Bifida, alongside folic acid
While folic acid is known to prevent many cases of Spina Bifida, most experts agree that not all cases are preventable. Up to 0.8 cases per 1,000 pregnancies are likely to persist regardless of folic acid usage. Indeed, studies in mice have shown that some strains with Neural Tube Defects respond to folic acid whereas others do not. A potential new preventive therapy is the use of inositol, which is effective in preventing Spina Bifida in one mouse strain, where folic acid is ineffective. A randomised clinical trial is now underway in the UK to determine whether inositol may be effective in preventing human Spina Bifida as in mice. We will not know the outcome of this study for several years but, in future, the recommendation might be for women planning a pregnancy to take inositol PLUS folic acid, for best possible protection from Spina Bifida.