Spina bifida: Why Folic Acid Before Pregnancy Is Crucial

Visit spina bifida is one of the neural tube closure defects. It occurs in the very first few weeks during pregnancy, often before even before a woman knows she is pregnant [1]. The good news: a simple supplement of folic acid Taking steps before conception significantly reduces this risk [2]. This article explains what spina bifida is, the preventive role of folic acid, current Canadian recommendations, and other measures to consider as part of preconception care.

On this page

• What Is Spina Bifida?
• The Role of Folic Acid
• Current Recommendations in Canada
• High-Risk Profiles
• Food Sources of Folic Acid
• Comprehensive Preconception Evaluation
• Prenatal screening and diagnosis
• Living with Spina Bifida
• Myths and Misconceptions
• Frequently asked questions
• Sources

What Is Spina Bifida?

Visit neural tube closes between the 3^e and 4^e week After the design, shaping the future brain And the spinal cord. When this closure is incomplete, we refer to it as’neural tube closure defect (AFTN). Spina bifida is the best-known form of this condition, with a wide range of severity [1].

The Main Forms

• Spina bifida occulta — the mildest form, often asymptomatic, sometimes discovered incidentally on imaging
• Meningocele — protrusion of the meninges without involvement of the spinal cord, generally with a better prognosis
• Spina bifida — the most severe form, with motor and sensory deficits below the level of the lesion
• Anencephaly — other neural tube defects, severe brain malformations, generally not viable
• Encephalocele — protrusion of a part of the brain or its membranes

Possible Consequences of Myelomeningocele

• Paralysis partial or complete paralysis of the lower limbs
• Sensory Disorders below the level of the lesion
• Hydrocephalus often requiring a bypass
• Malformation Type II Arnold-Chiari malformation
• Urinary and Intestinal Disorders (neurogenic bladder, neurogenic bowel)
• Orthopedic Abnormalities (foot deformities, scoliosis, hip dislocations)
• Increased risk latex allergy
• Impacts variables related to cognition and learning

Key Takeaways

• Visit spina bifida is a neural tube closure defect that occurs between the 3rd^e and 4^e week after conception [1]
• L’folic acid Preconception supplementation significantly reduces the risk of AFTN [2]
• All women Women of childbearing age who may become pregnant should take 0.4 mg (400 µg) of folic acid per day, ideally 2 to 3 months before conception [3]
• Visit women at increased risk (medical history, diabetes, certain anticonvulsants) may require higher doses (1 to 5 mg/day), to be determined in consultation with a doctor
• Supplementation is recommended in addition a diet rich in folate (green vegetables, legumes, fortified grains)
• The Results preconception also covers vaccines, chronic diseases, medications, lifestyle factors, STIs, and nutritional status
• A consultation before Pregnancy maximizes the chances of a healthy pregnancy

The Role of Folic Acid

L’folic acid is the concise form of the vitamin B9 (folate). It plays a role in the DNA synthesis and in the cell division. A deficiency during the critical weeks during pregnancy increases the risk of neural tube closure defects [2].

What the research has shown

• Visit randomized studies Studies from the 1990s (notably the British MRC study) have shown a sharp decline risk reduction through preconception supplementation
• Enrichment mandatory The fortification of flour with folic acid in Canada (since 1998) has contributed to a decrease the impact of AFTNs of approximately 50 %
• The preventive effect is maximum when supplementation begins before the design
• Folic acid is more bioavailable than natural dietary folates
• Visit needs Folate levels increase significantly in early pregnancy

Why Start Before Conception

• Visit neural tube closes within the first few weeks, before that most women know they are pregnant
• You have to 2 to 3 months so that blood folic acid levels reach a optimal concentration
• Nearly 50 % Some pregnancies are unplanned: Taking folic acid while planning a pregnancy or as soon as pregnancy becomes a possibility is the most effective preventive measure
• The protective effect is significant only if the concentration is sufficient at the time the neural tube closes

Current Recommendations in Canada

The Canadian guidelines, harmonized between the SOGC and Health Canada, are relatively simple and tailored to the risk profile [3].

Standard dose

• All women women of childbearing age who may become pregnant: 0.4 mg (400 µg) of folic acid per day
• To begin with at least 2 to 3 months before conception
• À continue throughout the first trimester, and ideally throughout the entire pregnancy
• Available alone or included in most prenatal multivitamins
• Accessibility Good: available over the counter at pharmacies, inexpensive

Dosage for women at increased risk

• Higher doses, to be determined in consultation with a doctor (often 1 to 5 mg (per day)
• Usual duration: 3 months before conception and during the first trimester, then reduce to 0.4–1 mg until the end of pregnancy, depending on the circumstances
• Tracking medical recommended
• Visit high doses (5 mg) are available by prescription in most cases

Comparison Table of Recommendations

Profile	Daily dose	Recommended duration
Standard Risk	0.4 mg (400 µg)	2–3 months before pregnancy
Diabetes, anticonvulsants, high BMI, malabsorption	1 mg	3 months ago + 1er quarter
Personal or family history of AFTN, previous pregnancy with AFTN	4–5 mg	3 months ago + 1er quarter

Dosages should be confirmed with a doctor based on the individual's specific needs.

High-Risk Profiles

Certain situations are increasing the risk of AFTN and warrant higher doses of folic acid, to be determined during a consultation [3].

Personal and Family History

• Previous pregnancy using an AFTN
• Personal History spina bifida in the mother or father
• Family history close relative (brother, sister, first-degree relative)
• Presence of a genetic condition partner

Medical Conditions

• Diabetes (type 1 or 2) present before pregnancy
• Obesity (BMI ≥ 35)
• Diseases malabsorption (celiac disease, inflammatory bowel diseases, bariatric surgery)
• Renal insufficiency on dialysis
• Anemia chronic hemolytic

High-Risk Medications

• Some anticonvulsants (valproic acid, carbamazepine, phenytoin, phenobarbital)
• Methotrexate (to be discontinued before conception)
• Trimethoprim, sulfasalazine
• Some anticancer drugs
• A review A comprehensive review of medications is essential as part of preconception care

Other factors

• Ethnic origin with prevalence higher (according to some studies)
• High consumption of’alcohol or drugs
• Smoking
• Documented Nutritional Deficiencies
• Exposition certain substances (to be confirmed during preconception counseling)

Food Sources of Folic Acid

L’folic acid is also found naturally in food. A balanced diet remains essential, but dietary intake alone is generally not enough to meet the preventive target. The supplementation is still recommended.

Folate-rich foods

• Dark green vegetables : spinach, kale, broccoli, asparagus, romaine lettuce, bok choy
• Pulses : lentils, chickpeas, black beans, red beans, split peas
• Enriched cereals in Canada (bread, pasta, breakfast cereals)
• Lawyer
• Citrus fruits (oranges, grapefruit) and their juices
• Eggs
• Liver (but should be avoided in large quantities during pregnancy because of vitamin A)
• Seeds sunflower seeds, walnuts
• Yeast nutritional

Why Supplementation Is Still Recommended

• L’dietary intake may vary from day to day
• Visit folates Food-based folate is less bioavailable than synthetic folic acid
• Visit cooking destroyed some of the folate
• Visit needs increase in early pregnancy
• Visit supplementation ensures a constant and sufficient supply
• Preventive target: 0.4 mg or more, which is difficult to achieve through diet alone

Are you planning a pregnancy and would like to discuss it with a professional? Omicron Clinic offers preconception consultations, prenatal care, and individual risk assessments at our locations in Quebec, with teleconsultations available. Make an appointment or opt for the teleconsultation.

Comprehensive Preconception Evaluation

Visit preconception counseling covers several aspects that contribute to a healthier pregnancy. It is recommended Ideally, 3 to 6 months before conception [4].

Vaccination Update

• Rubella : Check for immunity through serology; if not immune, get vaccinated before pregnancy (with a waiting period)
• Varicella : Check immunity; vaccinate if not immune
• Whooping cough (dcaT): recommended during pregnancy (between 27 and 32 weeks)
• Influenza annual
• COVID-19 in accordance with current recommendations
• Hepatitis B depending on the status
• According to the PIQ (Quebec Immunization Protocol)

Optimizing the Management of Chronic Diseases

• Diabetes : Optimize HbA1c levels before conception (target often ≤ 6.5 %)
• Thyroid : Optimizing TSH (specific target at the start of pregnancy)
• Hypertension : Choosing Safe Antihypertensive Medications During Pregnancy
• Asthma : well-controlled, compatible treatments
• Epilepsy : selection of anticonvulsants with a lower teratogenic risk, minimum effective dose
• Mental health : Optimizing treatment; selecting appropriate antidepressants based on the patient's situation
• Autoimmune Diseases : adjusting treatments in collaboration with specialists

Medication Review

• Identify Medications teratogens or potentially risky
• Substitution with safer alternatives
• Adjustment doses
• Discussion benefits and risks for essential medicines
• Don't never stopping a medication without medical advice
• Database Reference IMAGe (Information on Medications During Breastfeeding and Pregnancy, CHU Sainte-Justine)

Lifestyle

• Quitting Smoking : proven protective effect on pregnancy
• Quitting Alcohol from the planning stage onward (no safe dose)
• Stop recreational drugs, including cannabis
• Physical Activity appropriate regular exercise
• Sleep high-quality
• Infringement a healthy weight, if possible
• Management stress

ITSS Report

• Screening for HIV, hepatitis B and C
• Chlamydia, gonorrhea, syphilis
• Treatment before conception—so relevant
• Discussion on the prevention STIs During Pregnancy

Nutritional Assessment

• Folic acid (covered above)
• Iron : Screening and Treatment of Iron-Deficiency Anemia
• Vitamin D : supplementation is often recommended
• Iodine : adequate intake (iodized salt, prenatal supplements)
• Calcium : adequate intake
• Omega-3 : recommended based on profile
• Reference in nutrition as needed (OPDQ — Ordre professionnel des diététistes du Québec)

Genetic Counseling

• Family history genetic diseases
• Ethnic Origin with an increased prevalence of certain diseases (Tay-Sachs disease, sickle cell disease, cystic fibrosis)
• Screening carriers recommended based on the context
• Reference in medical genetics if needed

Prenatal screening and diagnosis

Spina Bifida Screening During Pregnancy

• Ultrasound on the 2nd^e Second trimester (around 18–22 weeks): detailed morphological examination, the primary screening method
• Alpha-fetoprotein (AFP) in maternal blood: elevated in cases of open AFTN
• Program Quebecois prenatal screening in accordance with current guidelines
• Fetal MRI in certain specialized situations
• Discussion Options in the Event of a Prenatal Diagnosis of AFTN

If spina bifida is suspected

• Reference in fetal-maternal medicine (Sainte-Justine University Hospital, CHUL, MUHC, and other specialized centers)
• Ultrasound specialized for confirmation
• Discussion multidisciplinary : pediatric neurosurgery, obstetrics, genetics, neonatology
• Information about the forecast and treatment options
• Option to fetal surgery prenatal care for certain specific conditions
• Support psychological and support
• Decisions respectful informed parental choice

Living with Spina Bifida

Multidisciplinary Care

• Neurosurgery : Initial management, shunting for hydrocephalus
• Urology : management of neurogenic bladder, prevention of kidney failure
• Orthopedics : birth defects, scoliosis, mobility
• Physical Therapy and occupational therapy
• Gastroenterology : neurogenic bowel
• Pediatrics specialized and multidisciplinary clinical
• Tracking in the long term, through adulthood
• Support psychosocial and educational

Quality of Life and Independence

• Many people with spina bifida have a active life and independent
• School Enrollment often in a regular classroom with support
• Adapted Sports, social activities, professional life
• Life expectancy significantly improved with modern medical care
• The prognosis depends on the severity initial diagnosis and the quality of care
• Support for families by specialized agencies

Resources in Quebec and Canada

• Quebec Association for Spina Bifida and Hydrocephalus (ASBHQ)
• Spina Bifida and Hydrocephalus Association of Canada (sbhac.ca)
• Spina Bifida Clinics specializing in pediatric university hospitals
• CRDP (regional rehabilitation centers for people with physical disabilities)
• OPHQ (Quebec Office for Persons with Disabilities) for support and assistance with administrative procedures
• Support Groups parental and community-based

Myths and Misconceptions

«A healthy diet is enough; there's no need for supplements.»

Insufficient. Even a diet balanced generally does not cover preventive care. Supplementation is recommended by all authorities Canadian guidelines for women of childbearing age. Diet remains essential, but in supplement.

«I'll take folic acid when I'm pregnant.»

Too late. Visit neural tube closes in the first few weeks during pregnancy, often before the woman knows she is pregnant. Starting once the pregnancy has been confirmed is too late for maximum preventive effect. You should start at least 2 to 3 months before conception.

«The higher, the better»

False. The standard dose (0.4 mg) is sufficient for most women. The higher doses are reserved for high-risk individuals. Prolonged, excessive supplementation provides no additional benefit and may hide a vitamin B12 deficiency. Follow recommendations tailored to the profile.

«Spina bifida is rare.»

Less common thanks to prevention. The incidence has decreased by approximately 50 % in Canada since the mandatory fortification of flour with folic acid and the promotion of preconception supplementation. This is specifically It is this prevention that makes the disease less common. Without prevention, the incidence would rise again.

«Supplementation is only for women»

Mainly for women, but not exclusively. A Balanced Diet including folates is recommended for everyone. For those men, some data suggest that a father’s nutritional status may influence fertility and sperm quality, although there are no specific recommendations for routine supplementation. The focus Prevention continues to be the mother's responsibility during the preconception period and pregnancy.

Frequently asked questions

When should you start taking folic acid?

Ideally 2 to 3 months before conception and throughout the first quarter. As nearly as half Since some pregnancies are unplanned, several authorities recommend that all women of childbearing age who are likely to become pregnant take folic acid regularly, even if they aren't planning to get pregnant right away.

Does folic acid have any side effects?

The standard dose (0.4 mg) works very well tolerated. Side effects are rare at the recommended doses. At very high doses, mild digestive problems, nausea, and, more rarely, skin rashes may occur. Long-term supplementation with high doses may hide a vitamin B12 deficiency and requires medical follow-up.

Prenatal multivitamin or folic acid alone?

Both options are valid. A prenatal multivitamin provides folic acid more other important nutrients (iron, iodine, vitamin D, B12). The’folic acid alone is less expensive and sufficient if the diet is balanced. The discussion Consulting with a doctor or pharmacist allows you to make a choice based on your personal circumstances and budget.

Should we continue after the first quarter?

The effect Preventive Measures for Spina Bifida is concentrated in the first quarter. However, most professional organizations recommend continuing a prenatal multivitamin containing folic acid throughout pregnancy and during breastfeeding, for other nutritional benefits (fetal growth, prevention of maternal anemia).

Does folic acid prevent other birth defects?

L’main evidence concerns the prevention of AFTN. Some studies suggest a possible protective effect against other malformations (heart defects, cleft lip and palate, certain urinary tract anomalies), but the evidence are less solid. The supplementation remains recommended for its proven effect on AFTNs, with potential additional benefits.

And after pregnancy, should you keep doing it?

For the’breastfeeding, several authorities recommend continuing to take a prenatal multivitamin or an appropriate supplement. For women of childbearing age who may become pregnant again, ongoing supplementation is recommended. Outside of these situations, a balanced diet rich in folate is usually sufficient.

Sources

1. Spina Bifida and Hydrocephalus Association of Canada (SBHAC). Information on Spina Bifida and Hydrocephalus.
2. De-Regil LM, et al. Effects and safety of periconceptional oral folate supplementation. Cochrane Database of Systematic Reviews.
3. Society of Obstetricians and Gynecologists of Canada (SOGC). Recommendations on Folic Acid and Pregnancy.
4. Health Canada. Folic Acid and Pregnancy — Official Information.
5. INESSS — National Institute for Excellence in Health and Social Services. Guides and Reviews on Preconception and Prenatal Care in Quebec.
6. IMAGe (Information on Medications During Breastfeeding and Pregnancy) — Sainte-Justine University Hospital. Information on Medications and Pregnancy.
7. Quebec Association for Spina Bifida and Hydrocephalus (ASBHQ).

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