Spina Bifida

<body bgcolor="#FFFFFF" background="../../images/FCTBACK.GIF"> <table border="0" cellpadding="0" cellspacing="0" valign="top" align="left"> <tr> <td width="87" valign="top" align="left"> <table border="0" cellpadding="0" cellspacing="0" width="90%"> <tr> <td align="center" height="45"> </td> </tr> <tr> <td align="center" height="45"> <img border="0" vspace="0" src="../../images/fservice.gif" width="70" height="32"> </td> </tr> <tr> <td align="center" height="45"> </td> </tr> <tr> <td align="center" height="45"> <a target="BODY" href="../"></a> </td> </tr> <tr> <td align="center" height="45"> <img border="0" vspace="0" src="../../images/FHELP.GIF" width="70" height="32"> </td> </tr> <tr> <td align="center" height="45"> </td> </tr> <tr> <td align="center" height="45"> <img border="0" vspace="0" src="../../images/FNWSLTR.GIF" width="70" height="32"> </td> </tr> <tr> <td align="center" height="45"> <img border="0" src="../../images/help.gif" width="30" height="40"> </td> </tr> </table> </td> <td valign="top" aligh="LEFT"> <table border="0" cellpadding="2" cellspacing="0" width="100%"> <tr> <td valign="bottom"><font size="+1">FOLIC ACID</font></td> </tr> <tr> <td valign="top"> <a target="BODY" href="../factbdy.html"><img border="0" align="left" hspace="0" src="../images/dfacts.gif" width="104" height="20"></a> <a target="BODY" href="../implicat/physical/mobility/home.html"><img border="0" hspace="0" align="left" src="../images/dimplic.gif" width="152" height="20"></a> <a target="BDY" href="home.html"><img border="0" hspace="0" align="top" src="../images/hfolic.gif" width="142" height="20"></a><br> </td> </tr> </table> <p><br> <br></p> <table border="0" cellpadding="2" cellspacing="0"> <tr> <td valign="top"> <table border="0" cellpadding="0" cellspacing="0" width="170"> <tr> <td> <a name="INTRO" id="INTRO"> <hr> <p><font color="#333399" size="+1">INTRODUCTION</font></p></a> </td> </tr> </table> </td> <td valign="top"> <hr> <p>For over 20 years, evidence has been mounting that maternal diets, and in particular the amount of folic acid or folate in the diet, has a role to play in the prevention of neural tube defects, such as Spina Bifida.<br> <br> <br> <br> <br> <a target="BDY" href="bdy.html#TOP"><img border="0" src="../../images/UP.GIF" width="24" height="24"></a></p> <hr> </td> </tr> <tr> <td valign="top"> <a name="FOLIC" id="FOLIC"><font color="#333399" size="+1">FOLIC ACID</font></a> </td> <td> Folic Acid is a B group vitamin found in many fruits, leafy green vegetables, cereals, and legumes(listed in Table A below). In pregnant women, folic acid is necessary for cell division in the developing embryo, and is involved in the closure of the neural tube. <p>Adequate folic acid levels become crucial during the early days of the embryo's development, particularly in the 3rd and 4th week after conception.</p> <p>In Australia approximately 1 in 500 involves a neural tube defect and about half of these have spina bifida. About 80 pregnancies a year in Queensland are affected by neural tube problems.</p> <p>It has been found that couples with a family history of neural tube defects have a significantly greater than normal risk of having a child with a neural tube defect. For women who have had an affected pregnancy the risk is 20 times higher.<br> <br> <br> <br> <br> <a target="BDY" href="bdy.html#TOP"><img border="0" src="../../images/UP.GIF" width="24" height="24"></a></p> <hr> </td> </tr> <tr> <td valign="top"> <a name="RESEARCH" id="RESEARCH"><font color="#333399" size="+1">RESEARCH</font></a> </td> <td> Several recent large-scale studies have provided conclusive evidence, that folic acid supplementation can effectively reduce the risk of having a child with one of these conditions. Some studies have shown that the risk can be reduced by as much as 70%. <p>Very little research has been done on the effects of increasing naturally occurring folate in the maternal diet. However the few studies that have been done seem to indicate that the risk of having a child with a neural tube defect is lessened by including more folate rich foods in the diet, although not as much as by taking supplement.</p> <p align="center"><b>TABLE A</b></p> <p align="center">Good Food Sources for Folate</p> <div align="center"> <center> <table border="1" cellpadding="0" cellspacing="0" width="80%"> <tr> <td valign="top" align="center" width="50%"> Leafy Green Vegetables. <p>broccoli<br> spinach<br> Brussels sprouts<br> cabbage<br> asparagus</p> </td> <td valign="top" align="center" width="50%"> Legumes <p>peas<br> kidney beans<br> butter beans<br> chickpeas<br> lentils</p> </td> </tr> <tr> <td valign="top" align="center"> Cereals <p>bran cereal/bran<br> oats<br> Weet Bix/Vitabrits</p> </td> <td valign="top" align="center"> Fruit <p>oranges<br> bananas<br> berries</p> </td> </tr> </table> </center> </div> <p>NOTE: Folate id the term for the naturally occurring vitamin. Folate is water soluble, and is easily destroyed by heat and other processing. Vegetables are best eaten raw or cooked lightly - by microwave or steaming.<br> <br> <br> <br> <br> <a target="BDY" href="bdy.html#TOP"><img border="0" src="../../images/UP.GIF" width="24" height="24"></a></p> <hr> </td> </tr> <tr> <td valign="top"> <a name="RECOMM" id="RECOMM"><font color="#333399" size="+1">Recommendations Re Folic Acid</font></a> </td> <td> The National Health and Medical Research Council(NHMRC) has examined the evidence, and in June 1993, made several recommendations regarding folic acid, These include: <p>1.All women planning a pregnancy or likely to become pregnant should be offered advice about folate in the diet and encouraged to increase their dietary intake of folate rich foods, particularly in the month before and in the first three months of pregnancy.</p> <p>2.Low risk women(no family history of neural tube defect, not on anticonvulsant), should be offered folic acid supplements. The recommended supplement is 0.5mg (or 500mcg) tablets daily, for one month before and the first three months of pregnancy. This is available at low cost over the counter at local pharmacies/health food outlets N>B> 0.5 milligrams (mg.) = 200 micrograms (mg.) = one low dose folic acid tablet.</p> <p>3.Women with a close family history of neural tube defects (e.g: they or their partner has spina bifida, they have already had an affected child, they or their partner have a sibling or close relative with neural tube defect)</p> <p>* should be referred for genetic counselling. *should be advised to take folic acid supplements. the dose recommended for low-risk women is not sufficient for women in this category. these women should take a 5mg (5.000mcg) tablet daily, for one month before, and three months into pregnancy.</p> <p>* Should be offered pre-natal diagnosis</p> <p>Although the risk of recurrence is significantly reduces if folic acid supplementation is used appropriately, there is still a chance that a couple will have a child with neural tube defect.</p> <p>4.Women on anticonvulsive drugs - it has been found that women on some anti-convulsants (notably sodium valproate - Epilim) have an increased risk of having a child with a neural tube defect.</p> <p>However, there is a theoretical risk high doses of folic acid may reduce the power of the anti-convulsant. therefore, these women should take folic acid supplement only under the supervision of and close monitoring by their physician(Reference 2)</p> <p>It has also been discovered that mothers with maternal diabetes ate at an increased risk of having a child with a neural tube defect(Reference 3)<br> <br> <br> <br> <br> <a target="BDY" href="bdy.html#TOP"><img border="0" src="../../images/UP.GIF" width="24" height="24"></a></p> <hr> </td> </tr> <tr> <td valign="top"> <a name="FORTIFY" id="FORTIFY"><font color="#333399" size="+1">FORTIFICATION</font></a> </td> <td> In an effort to increase levels of folic acid in the diet of all women of child-baring age, not only those who are planning a pregnancy, companies are now able to fortify some staple foods, such as bread and cereals with folic acid. <p>This also offers another way for women to increase their dietary intake of folate when planning pregnancy.</p> <p>At present, fortification of foods has just commenced, but we hope that more and more products will be fortified with folic acid in the near future. Check the label to determine if a food has added folate.<br> <br> <br> <br> <br> <a target="BDY" href="bdy.html#TOP"><img border="0" src="../../images/UP.GIF" width="24" height="24"></a></p> <hr> </td> </tr> <tr> <td valign="top"> <a name="CURRENT" id="CURRENT"><font color="#333399" size="+1">Currently, fortified products include</font></a> </td> <td> <ul type="square"> <li>Weet-Bix from Sanitarium</li> <li>Light Start form Uncle Toby's</li> <li>Nearly all of the breakfast cereals from Kellogg's</li> </ul> <p><br> <br> <br> <br> <br> <a target="BDY" href="bdy.html#TOP"><img border="0" src="../../images/UP.GIF" width="24" height="24"></a></p> <hr> </td> </tr> <tr> <td valign="top"> <a name="WHOLE" id="WHOLE"><font color="#333399" size="+1">Not the Whole Picture</font></a> </td> <td> While folic acid has been shown to help prevent neural tube defects, it is still not known exactly how and why it works. However, Spina Bifida and other NTDs are not caused simply by a deficiency of folic acid in the diet <p>While folic acid can significantly reduce the risk of having an affected child, some children are still born with spina bifida and other NTDs</p> <p>It is not known what other factors may be involved.</p> <p>It is important to emphasise that the development of the neural tube takes place very early in pregnancy, at this point many women are not even aware that they are pregnant. that is why it is important for all women who are capable of becoming pregnant consider folic acid supplementation now. rather than when they discover they are pregnant BY THEN IT IS TOO LATE.</p> <p>Folic acid is considered to be a safe substance, with no harmful effects having been demonstrated at the level recommended for supplementation. If a vitamin B12 deficiency (very rare in women of child baring age) is present, increases in folic may complicate its diagnosis.</p> <p>Generally supplementation with other vitamins prior to conception is not necessary. When supplements (other that folic acid) are used, such as multivitamins, the potential risk of vitamin overdose needs to be considered. In particular, large doses of vitamin A may actually cause birth defects.</p> <p>Many other factors can affect the health of your baby. To give your baby the best possible chance for a healthy start in life, you should consider:</p> <p>1.eating well balanced diet. for ALL the nutrients you and your baby need</p> <p>2.giving up smoking cigarettes, if you smoke. Smoking has been proven to have harmful effects on an unborn baby</p> <p>3.giving up, or at least cutting down on alcohol. the NHMRC now recommends that women do not drink alcohol at all during pregnancy</p> <p>4.advice other drugs/medications as much as possible, except on the recommendation of your doctor. Some drugs are definitely harmful to pregnancy. Consult you doctor if in doubt.<br> <br> <br> <br> <br> <a target="BDY" href="bdy.html#TOP"><img border="0" src="../../images/UP.GIF" width="24" height="24"></a></p> <hr> </td> </tr> <tr> <td valign="top"> <a name="GENETIC" id="GENETIC"><font color="#333399" size="+1">GENETIC COUNSELLING</font></a> </td> <td> If you believe you are in the 'high risk' category, for having a child with a NTD, you should be referred for genetic counselling. Genetic counselling involves a specially trained professional outlining to couples their personal risk of having a child with a medical condition, by examining family history. <p>It is preferable that you have referral from your doctor, but this is not essential.</p> <p>the Queensland Clinical Genetics Service provides an outreach service, so you may be able to access genetic counselling in a nearby town, if you live in a rural area.</p> <p>please contact the service for more details</p> <p align="center"><b>QUEENSLAND CLINICAL GENETICS SERVICE</b><br> ROYAL Children's HOSPITAL<br> Back Road, Bramston Terrace Entrance,<br> Herston, Brisbane, QLD, Australia 4029<br> Phone: +61 07 3253 1686<br> phone: +61 07 3253 1987<br></p> <p align="center"><b>Mater Children's Hospital</b><br> Annerley Road<br> South Brisbane, Brisbane, OLD, Australia 4101<br> Phone +61 07 3840 1594<br> <a name="BOTTOM" id="BOTTOM"><br> <br> <br> <br> <br></a> <a target="BDY" href="bdy.html#TOP"><img border="0" src="../../images/UP.GIF" width="24" height="24"></a></p> <hr> </td> </tr> <tr> <td valign="top"> <a name="FURTHER" id="FURTHER"><font color="#333399" size="+1">Further Information</font></a> </td> <td> The Queensland Association for People with Spina Bifida or Hydrocephalus (QAPSBH) can provide further information , advice and support. Please contacts us. <p>However, for information on your own circumstances, please consult your doctor.<br> <br> <br> <br> <br> <a target="BDY" href="bdy.html#TOP"><img border="0" src="../../images/UP.GIF" width="24" height="24"></a></p> <hr> </td> </tr> </table> <table border="0" cellpadding="2" cellspacing="0" width="100%"> <tr> <td valign="bottom"><font size="+1">FOLIC ACID</font></td> </tr> <tr> <td valign="top"> <a target="BODY" href="../factbdy.html"><img border="0" align="left" hspace="0" src="../images/dfacts.gif" width="104" height="20"></a> <a target="BODY" href="../implicat/physical/mobility/home.html"><img border="0" hspace="0" align="left" src="../images/dimplic.gif" width="152" height="20"></a> <a target="BDY" href="/home.html"><img border="0" hspace="0" src="../images/hfolic.gif" width="142" height="20"></a><br> </td> </tr> </table> </td> </tr> </table> </body>