Inside Pediatrics Fall/Winter 2023-2024

SPINA BIFIDA AND FOLIC ACID SB is the most frequently occurring, permanently disabling birth defect to affect the nervous system. It results from the spine’s failure to close properly during the first month of pregnancy. The cause of SB is not fully understood, but it is thought to be associated with both genetic and environmental factors. The most important environmental factor is maternal intake of dietary FA, a B vitamin that is critically important in development and has long been known to reduce the risk of neural tube defects (NTDs), such as SB. Nutritional shortage of FA in women of childbearing age is the most important contributor to SB prevalence worldwide. Many women supplement FA in their diet by taking 400 micrograms of FA while pregnant. But, in some cases, that’s not soon

NTDs affect up to

150 BIRTHS PER 10,000 in regions that don’t fortify

enough. “This problem of spina bifida occurs so early on in development that it has already occurred before most women even realize they’re pregnant,” Blount said. “So, it’s not like they can realize they’re pregnant, change their nutritional strategy and put up an effective barrier for this problem. Once they realize they’re pregnant, if they have the problem, it’s already occurred.” Fortifying widely consumed foods such as corn, grain or rice is more effective, which is why GAPSBiF works so hard to promote this strategy. EVIDENCE THAT FORTIFICATION HELPS In the United States, mandatory fortification of enriched cereal grain products with FA was authorized in 1996 and fully implemented in 1998. Here, NTDs, including SB, affect approximately seven out of every 10,000 births. The rates in other regions that fortify are similar. In regions that don’t fortify, NTDs affect up to 150 births per 10,000. But some countries—even advanced Western European nations—still are not practicing fortification, and, in many cases, are focused more on detection. But that approach can be problematic, Blount says. “Some places are very aggressive at terminating those pregnancies, which of course is a very difficult, very challenging, whole approach to problems. But it’s surprisingly widespread.”

GAPSBiF’s approach is centered around prevention. “Let’s keep these little children from getting this terribly difficult disease,” Blount said, “because it’s lifelong.”

Diagnosed with severe spina bifida in utero, Logan McCool was transferred to Children’s of Alabama the day after her birth for treatment and surgery. After being monitored in the Neonatal Intensive Care Unit for 30 days, she was transferred to a step-down unit and later discharged home, where she has thrived. Logan continues to visit the Children’s Pediatric Spina Bifida Clinic twice a year and looks forward to learning to walk in custom orthotics. “I very much appreciate how the doctors at Children’s stay on top of everything,” Logan’s mom, Candice, said. “Every time we go, they are checking everything so that if something is wrong, it’s caught quickly. Logan now serves as one of the 2023-24 Children’s Miracle Network Hospital National Champions.

Logan McCool

5

Inside Pediatrics | Children’s of Alabama