Folic Acid and the Hand of Hope

in Motherhood9 months ago (edited)

For those that are already pregnant or still seeking the fruit of the womb, taking an adequate amount of folate comes highly recommended. Adequate folate, among other nutrients, might be the difference between having a complete and healthy baby and a baby with birth defects. The compound has been found to be essential in cell division.

Luckily enough, folate, a compound that is a natural form of vitamin B9, is present in many commonly consumed foods such as eggs, seafood, beans, peanuts, liver, and several other foods. This means that all what hopeful and expectant mothers need to do is adapt their diets such that an adequate amount of folate is consumed. Quantitatively, about 400 micrograms of folate is recommended per day. In the absence of that, folate is available as over-the-counter supplement and nomenclatured as folic acid.

Inadequate folate has been shown to result in babies with neural tube defects. This is an abnormality that affects the brain, the spinal cord, and the spine altogether. The two most common physical manifestations of this abnormality are spinal bifida and anencephaly.

Babies with spinal bifida suffer from partial closing of the neural tube which is often manifested as physical or intellectual disability or both, depending on the severity of the opening.

Anencephaly is a different ball game entirely. Babies with such a defect come with parts of their skull and brain completely missing, leaving a chasm and often hardly survive beyond a few hours after been given birth to. Both conditions have low incidence rates with only an average of about 1,500 cases of spinal bifida and 1,000 cases of anencephaly reported yearly in the United States.

The two most common neural tube defects can be diagnosed while the baby is still in the womb as early as the 15th to 22nd week after fertilisation. Presumptive diagnosis can be done either by using quad screen test or ultrasound. Positive presumptive tests would require confirmation and this is often achieved by carrying out a comprehensive ultrasound of the skull and spinal cord of the growing embryo or conducting amniocentesis.


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source: Wikimedia commons

Your baby being diagnosed of spinal bifida may not be the end of the world, unlike anencephaly which currently has no known cure or standard treatment. In other words, something can still be done to fix spinal bifida, usually bordering around surgery. Once it is confirmed that the growing baby is inflicted with spinal bifida, there are two options available:

  1. Surgery before birth - fetal surgery
  2. Surgery after birth - infant surgery

Even though fetal surgery has been reported to have shown better results over infant surgery, it is highly recommended that fetal surgery is opted for only at specialty centers with experienced fetal surgery team due to higher risk of complication. The developing fetus is brought out via Caesaren Sectioning and the opening or openings closed up by series of medical procedure before being returned to the womb and the mother stitched up for the baby to continue it's normal development.

The infant surgery to fix spinal bifida is conducted within a few hours after birth. The neural tissue is put back into the spinal canal by a competent specialist before the muscles and skin around the area is closed up, sometimes by plastic surgeons.

The interesting case of Samuel Alexander Armas

The lesson about neural tube defects would be incomplete without the story of Samuel Alexander Armas and the infamous hand of hope. The now surgeon was just about 21 weeks old in his mother's womb when it was discovered that he had spinal bifida. To correct the anomaly, a team of surgeon came together, opened the mother up, brought out Samuel before carefully fixing the defect. Just when they were about stitching the mother up after returning Samuel into the womb, he brought out his tiny hand and grab a finger of one of the surgeons in a way that gesticulates hope and gratefulness. More about the story can be found here.

Final Words

Neural tube defects in babies have been correlated with inadequate folate in the mother during the early developmental stages of pregnancy. However, there are other known risk factors associated with neural tube defects. These include genetic factors, obesity, diabetes, and side effects of certain drugs. Research has it that taking adequate folate before and during early stages of pregnancy reduces the risk of having a baby with neural tube defect by about 70 to 80%.

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Isn’t the vitamin B12 the one that may be an issue for vegetarian people if they don’t pay attention to it? As I am not vegetarian I don’t remember the information, I cannot double check this right now.

Coming back closer to the topic, do you have quantitative estimates for other parts of the world, on top of those provided for the US. I am wondering how many babies are actually affected. Considering the US, we are discussing numbers of the size of half a permille. That’s not that large (of course, it is awful when it happens).

PS: Samuel Armas' story was an amazing story to read about ;)

Sorry, totally forgot to respond appropriately to this.

First, folate is actually vitamin B9 and not B12 (I have made that correction above). It also appears one does work for the other.

Then to your question, yes. B12 is found in mostly in meat and meat products (along with b9, anyways), so definitely, it follows logically that vegetarians may have issues with it.

Unfortunately, there are no enough data for other areas of world as far as neural tube defects are concerned. However, there are reports of around 500,000 cases global annual. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4827875/

Thanks for the answer, which fixes my thoughts for the B12 thingie, even if it is now irrelevant ;)

For the rest, I was imagining such an answer, as those studies are hard to achieve globally. Thanks for the link anyways. It covers at the end 24 years worldwide, which is not that bad, and provides results sufficient to get an idea even if the error bars are large.

It was a pleasure to do that for my Prof! :)

Even in vegeterian, due to less vit b12, anemia occurs so called megaloblastic anemia. This anemia can also be seen in patient with less vit b9 so called folic acid deficiency. First make sure it’s vit b12 or b9 deficiency because treating people with folic acid in case of vit12 deficient can worsen the neurological symptoms more of the patient.
P.S. Both are used in DNA synthesis .

Thanks for those specifications! Please note that I am by no mean in medicine, so that I am a complete newbie with this respect. I have just read a few things here and there ;)

Yes I was going to ask about that, too. My interpretation is that there's probably many forms of vitamin b12, and folate is one of them, and it's not the one vegetarians have an issue with. So let's wait for gentleshaid to solve the mystery.

Folate is actually b9, not b12. B12 is what vegetarians may be deficient of. I have made a bit of clarification above.

Let's do this. Hopefully the answer will come (tagging again @gentleshaid ;) ).

Thanks G for this article, when we got pregnant our OB advised my wife to regularly consume folate and took some supplements throughout the journey until birth. Our kiddo was a healthy one w/o any defects and whatnot.

We are also told the same thing, if planning to have one in the future a good amount of folate will be better.

You are welcome. My greetings to your lovely family

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