Neural tube defects and the role of folic acid in Lowering the Risk.pdf

OM VERMA
ASSOCIATE PROFESSOR
GRACIOUS COLLEGE OF NURSING ABHANPUR RAIPUR C.G

1. GRACIOUS COLLEGE OF NURSING
RAIPUR C.G.
Neural tube defects and the role of folic
acid in Lowering the Risk acid in Lowering the Risk
PRESENTED BY
OM VERMA
ASSISTANT PROFESSOR

2. NEURAL TUBE DEFECTS

3. INTRODUCTION
The most common birth defect in India in neural
tube defect
Neural tube –
Embryonic precursor to central nervous system which Embryonic precursor to central nervous system which
is a made up of the brain and spinal cord. Neural tube Defect
–it is a defect in the covering
of the brain and spinal cord it is called Neural t ube
Defect.

4. According to Peter J

5. Sternberg
According to Sternberg

6. Neural tube defect it is a define as failure of
closure of the neural tube during 3
rd
and 4
th
Week of pregnancy ( first month of
embryonic life ) it is called neural tube
defect . defect .
According to simmons

7. TYPES OF
NEURAL TUBE DEFECT

8. There are 3 types of neural tube defect :-
1.Anencephaly 2.
Encephalocele
2.
Encephalocele
3.Spina Bifida

9. 1.ANENCEPHALY :-
Anencephaly isa serious birth defect in which a baby is bor n
without parts of the brain and skull. Anencephaly is a de fect in
the formation of a baby's neural tube during developme nt. It is
a type of neural tube defect
, it occurs when the head end of
a type of neural tube defect
, it occurs when the head end of
the neural tube fails to close .it is characterized by the
absence of a major portion of the brain and skull .infa nts either
die with in the uterus /die with in the few hours or days after
birth.

11. Encephalocelehappens when the neural tube does not close completely
2. ENCEPHALOCELE
neural tube does not close completely during pregnancy. It is a neural tube
defect characterized by Sac like
protrusion of the brain through the
opening in the skull.

12. ENCEPHALOCELE sac-like protrusions of the brain and the
membranes that cover it through
openings in the skull.

13. 3.SPINA BIFIDA
A birth defect in which a developing baby's spinal cord
fails to develop properly.
It occurs when a developing baby's spinal cord fail s to It occurs when a developing baby's spinal cord fail s to develop or close properly while in the fetus.
Symptoms can sometimes be seen on the skin above
the spinal defect. They include an abnormal tuft of hair,
a birthmark or protruding spinal cord tissue.

15. Abnormal
opening in the
vertebral
column is called
spinabifida

16. Their 3 types of spinabifida
1. Spina bifida oculta
2. Meningocele 2. Meningocele 3. Meningomyelocele

18. 1. SPINA BIFIDA OCULTA
Spina bifida occulta(SBO) is a common malformation of the
spine. It occurs during a baby's development in its mother' s uterus
, Spina bifida occultaiswhen a baby's backbone (spine) does
not fully form during pregnancy. The baby is born with a small
gap in the bones of the spine.
It is most common neural tube
gap in the bones of the spine.
It is most common neural tube
defect which involves the spinal cord .it is caused by failure
of the closure of lower portions of the neural tube .and visible
sign is a dimple in the skin of the area or tuft of hair are
present.

19. 2. MENINGOCELE
Meningesand C.S.F. Are out from the defect
and these are the covered by the a
transparent membrane .
A meningocele is
a
transparent membrane .
A meningocele is
a
birth defect where there is a sac protruding from
the spinal column. no nerve damage.

20. 3. MENINGOMYELOCELE
MyelomeningoceleisanNTDin which the bones of the
spine do not completely form. This results in an
incomplete spinal canal. The spinal cord and
meninges
incomplete spinal canal. The spinal cord and
meninges
protrude from the child's back. myelomeningocele , part
of their spinal cord and nerves are in the sac and are
damaged

21. ETIOLOGY ETIOLOGY

23. GENETIC FACTOR
–
Caused bya combination of multiple
genes. neural tube defects can be
caused by genes passed on from both caused by genes passed on from both
parents (inherited). And genetic
material abnormality present in both
parents.

24. MATERNAL NUTRITION
(including folic acid deficiency) during
pregnancy poor diets lacking in key nutrients –like
iodine, iron, folate , calcium and zinc –can cause
anaemia
, pre
-
eclampsia
,
haemorrhage
and
anaemia
, pre
-
eclampsia
,
haemorrhage
and
death in mothers. They can also lead to stillbirth,
low birthweight, wasting and developmental delays
for fetus ,and neural tube defect.

25. ENVIRONMENTAL FACTORS
Th
at
affect fetal development
Smoking.
Metals.
Inhalational Anesthetics. Inhalational Anesthetics. Organic Solvents.
Air Pollution.
Pesticide Workers.
Radiation.
Stress.

26. POOR INTAKE FOLIC ACID
Within the first 28 days of pregnancy, the neural
tube, which is responsible for the development
of the brain and spine, closes.
Inadequate
of the brain and spine, closes.
Inadequate
concentrations of folatecan prevent closure
of the neural tube, which can lead to a neural
tube defect.

27. OBESE WOMEN
More severe obesity carried a higher risk of birth
defects, it's possible that health problems
related to excess weight such as
abnormal
related to excess weight such as
abnormal
metabolism, increased sensitivity to the
hormone insulin and impaired vascular
functionall might play a role to lead fetus NTD,

28. ANTIEPILEPTIC DRUGS (AED)
Antiepileptic drugs have chronic teratogeniceffect s,
the most common of which arecongenital heart
disease, cleft lip/palate, and neural tube defects.
Valproate
and
carbamazepine
include
minor
Valproate
and
carbamazepine
include
minor
anomalies, major congenital malformations,
intrauterine growth retardation, cognitive
dysfunction, low IQ, microcephaly, and infant
mortality.

30. spine

31. oFetal karyotyping

32. Alpha Fetoprotein In Amniotic Fluid And
Maternal Serum Test
AFP test is a test that is mainly used to measure t he level of alpha
-
fetoprotein (AFP) in the blood of a
level of alpha
-
fetoprotein (AFP) in the blood of a
pregnant person. The test checks the baby's risk fo r
having certain
genetic problems
and
birth defects
.
such as neural tube defects or Down syndrome

33. ACETYLCHOLINESTERASE (AChE) TEST
Raised specific acetyl-cholinesterase
(AChE) activity inamnioticfluid was
consistently found to be associated with consistently found to be associated with fetal intrauterine death and neural tube
defects,

34. FETAL KARYOTYPING TEST
This test can help identify genetic
problems as the cause of a disorder or
disease. Karyotyping isa test used to
identify chromosome abnormalities as identify chromosome abnormalities as the cause of malformation or disease.
The test can be performed on a sample
of blood, bone marrow, amniotic fluid, or
placental tissue.

35. Fetal (prenatal) ultrasound
:
An ultrasound during pregnancy is the most
accurate method to diagnose several NTDs.
Healthcare providers typically recommend Healthcare providers typically recommend
ultrasounds during the
first trimester
(11 to 14
weeks of pregnancy) and
second
trimester
(18 to 22 weeks of pregnancy).

36. Amniocentesis
:
Healthcare providers use this test to check for
NTDs and other birth defects. During
amniocentesis, they use a needle to remove amniocentesis, they use a needle to remove
a sample of fluid from the amniotic sac that
surrounds tefetus. You can get this test at 15
to 20 weeks of pregnancy. This test carries
certain risks

37. Management
There is no cure for neural tube defects. The nerve damage and loss of function that The nerve damage and loss of function that are present at birth are usually permanent.
But some management for some birth
defect.

39. Folate(folic acid) deficiency
:
Folate, the natural form of vitamin B -9, is important
for healthy fetal development. A folate deficiency
before and during pregnancy increases the risk of
having a baby with
spina
bifida and other NTDs. The
having a baby with
spina
bifida and other NTDs. The
Centers for Disease Control and Prevention (CDC)
recommends all people who can become pregnant
take 400 micrograms (mcg) of folic acid every day, in
addition to eating food with folate , to help prevent
NTDs.

40. Surgical management
Surgery for Neural Tube Defects
If the child's spinal cord is exposed to the skin, early surgical repair is essential to prevent infection a nd surgical repair is essential to prevent infection a nd
neurological deficits. Protrusion of sac can be clo sed
surgically after which assessment of growth and
development should be continued .

43. Prevention: To prevent the first occurrence of neural tube
defects, all women planning a pregnancy should adopt the
following:
1. Diet of women planning a pregnancy should be supplemented with folic acid.
2. Processed food such as bread, cereals, flour and other grains product
which are fortified with folic acid should be used.
3. Consume more folate rich foods and avoid overcooking which destroy the
folic acid.