The biggest breakthrough in prevention of Spina Bifida took place in the early 1980’s. Studies found that a key risk factor for a child to be born with Spina Bifida is a low level of the B vitamin folate (present in green leafy vegetables and in fruits) in the blood of the mother. If this level is too low, chances of having a child with Spina Bifida are vastly increased. In fact, research has shown that the probability of having a child with Spina Bifida can be reduced by 50% to 70% if women take folic acid (0.4 mg per day) before and during the first months of pregnancy.

From 1985 the Bo Hjelt Foundation sponsored the research on Spina Bifida of Professor Tom Eskes, Professor Emeritus, Department of Obstetrics and Gynecology at University of Nijmegen in The Netherlands. From the beginning of the 21th century research projects of the research line of Professor Regine Steegers-Theunissen, Department of Obstetrics and Gynaecology, Epidemiology, Pediatrics and Clinical Genetics, Erasmus University Medical Center, have been financially supported. This has lead to the following results:

An increased homocysteine level in the blood of the mother as a more sensitive marker of the folate and vitamin B12-status 2-3 fold increases the risk of Spina Bifida.

Deficiencies of other nutrients, such as inositol, zinc and other B vitamins are also involved in the risk for Spina Bifida.

Chromosomal abnormalities can be induced by a low folate status.

Maternal adherence to a mediterranean dietary pattern reduces the risk of a child with spina bifida by 70% comparable to the effect of the use of a tablet of 0.4 mg folic acid.

The expression of genes into proteins involved in the organ development of the fetus can be influenced by folic acid use.

The findings of this research supported the recommendations of folic acid use of prepregnant women, but stress the importance to find the lowest and safest dose. It also showed that not a single cause can explain Spina Bifida but that many factors, playing in concert, are involved. These factors vary from nutrients, medication, and lifestyles such as smoking to small genetic variations. This research also stimulated preconception care developments as well as the implementation of the research results into the first clinic on “healthy pregnancy” with a focus on nutrition and lifestyle at the Erasmus MC, in Rotterdam, The Netherlands.