Spina bifida treatment. What is spina bifida and can the disease be cured? Neurological examination and treatment

Spina bifida (spina bifida) is a complex congenital defect in the development of the spinal cord and spine. This is a type of open neural tube defect in which there is a developmental abnormality rear parts spine, spinal cord, surrounding nerves and/or the fluid-filled sac that surrounds the spinal cord.

Spina bifida (spina bifida) is an incurable, lifelong condition that affects the neuromuscular and musculoskeletal systems.

This defect varies among types and ranges from moderate to severe.

Children with such a defect may need corsets as their bodies grow. severe forms disabled carriage.

Treatment is mainly aimed at slowing down the deformity and maintaining motor activity.

The defect can occur along the entire length of the spine and may result in part of the spinal cord and surrounding tissue protruding outward rather than inward. Approximately 85 percent of defects occur in the lower back and 15 percent in the neck and thoracic region. Surgically, it is possible to restore the integrity of the spinal column, but nerve damage cannot be restored, and if it is severe, patients experience varying degrees of paresis of the lower extremities. The higher the defect is on the spinal column, the more severe the nerve damage and motor disorders (paresis and paralysis).

According to studies, this developmental anomaly occurs in 7 cases per 10,000 newborns. There are several types of spina bifida that have varying degrees gravity.

Symptoms

Symptoms of spina bifida vary widely, depending on the type and severity of the individual child. For example, at birth:

• With hidden cleft (spina bifida occulta), there may be no obvious signs or symptoms—just a small spot, depression, or birthmark.
• With meningocele, there will be a sac-like protrusion that will be located on the back in the spinal area.
• With myelomeningocele there will also be a protrusion, but with changed skin, there will be a release of nerves and the spinal cord.

In severe spina bifida, when localized in the lumbar spine, the following symptoms may be present: paralysis of the lower extremities, impaired function Bladder, intestines. In addition, such patients, as a rule, may have other developmental anomalies:

• Hydrocephalus occurs in 75 percent of myelomeningocele cases and this condition requires surgical endoscopic treatment in order to restore normal flow of cerebrospinal fluid or a shunt to drain excess fluid from the brain.
• Chiari malformation (displacement of the brain into the upper cervical vertebra) can cause pressure on the brain stem, which can manifest as speech, swallowing, and motor problems in the extremities.
• Underdevelopment of the spinal cord Orthopedic problems including scoliosis, kyphosis, dysplasia hip joints(congenital dislocation), combined deformities, clubfoot, etc.
• Premature sexual development(especially in girls with spina bifida and hydrocephalus).
• depression and other neurotic conditions
• obesity
• dermatological problems
• developmental anomalies of the urinary tract.
• heart disease
• vision problems

Diagnostics

Diagnostic tests may be performed during pregnancy to evaluate the fetus for the presence of spina bifida. These include:

• Amniocentesis: a procedure in which a long, thin needle is inserted through abdominal cavity mother into the amniotic sac to collect a small amount of amniotic fluid for examination. The fluid is analyzed to determine the presence or absence of an open neural tube defect. Although the analysis is very reliable, it does not diagnose small or closed defects.
• Prenatal ultrasound: this technique, being absolutely harmless, allows non-invasive assessment of the condition and visualization internal organs, vessels, fetal tissues. Sometimes it is possible to diagnose not only spina bifida, but also other anomalies.
• Blood tests: It is recommended that blood tests be performed between 15 and 20 weeks of pregnancy for all women who have not previously had a child with an open neural tube defect and who do not have family history such a disease. A blood test for alpha-fetoprotein and other biochemical indicators can determine how high the risk of developing spinal abnormalities is.
• At birth, severe cases of spina bifida are evident by the presence of a fluid-filled sac bulging on the newborn's back. Visual indicators of mild forms (spina bifida occulta) may include a hairy patch of skin or a depression along the spine. Unusual weakness or lack of coordination in the lower extremities also suggests spina bifida. In children and adults, this anomaly is often diagnosed during routine examinations or, if necessary, to differentiate neurological symptoms using instrumental methods studies (MRI, CT, radiography).

Causes

During pregnancy, the human brain and spinal column begin to form as a flat sheet of cells that folds into a tube called the neural tube. If all or part of the neural tube fails to close, the open area is called an open neural tube defect. A patent neural tube is open in 80 percent of cases, and is covered by bone or skin in 20 percent of cases. The cause of spina bifida (spina bifida and other defects) remains unknown but is most likely due to a combination of genetic, nutritional, and environmental factors, such as:

• deficit folic acid(vitamin B) in the mother's diet during pregnancy (taking enough folic acid during pregnancy may reduce the risk of developing this abnormality).
• uncontrolled maternal diabetes
• Some medications (antibiotics, anticonvulsants).
• The genetic factor usually plays a role in only 10 percent of cases.
• Mother's age
• What kind of births are there (firstborns are more at risk).
• Socioeconomic status (children born into lower socioeconomic families are at higher risk).
• ethnic origin
• obesity or excessive alcohol consumption in a pregnant woman
• When a pregnant woman is exposed to hyperthermia in the early stages (sauna, jacuzzi).

Treatment

Spina bifida can be treated immediately after birth. If this defect is diagnosed prenatally, a cesarean section is recommended in order to reduce possible damage to the spinal cord during fetal passage. birth canal. In newborns with meningocele or myelomeningocele, it is recommended that surgical treatment within 24 hours after birth. With this operation, the bone defect is closed and the function of the undamaged part of the spinal cord is preserved. Unfortunately, surgery cannot restore the functions of damaged nerves as they are irreversible.

Currently, there are clinics that perform prenatal surgeries to close the defect, but the techniques have not yet found widespread use. The main task of treating both non-severe forms and postoperative period, is to preserve the functions of both the musculoskeletal system and the functions of the bladder and intestines. If necessary, orthoses are used, physiotherapy, physiotherapy.

In cases where spina bifida is discovered by chance during an X-ray (MRI, CT) examination, it is necessary to take measures to reduce the risk of damage to the spinal cord in the area of ​​the spine where this defect exists.

Surgical treatment in adults is used only in the presence of complications. Basically, treatment in adults is aimed only at prevention possible complications(exercise therapy, physiotherapy, wearing a corset).

Congenital anomalies are undoubtedly one of the main fears of all pregnant women.

Diseases affecting the central nervous system - the brain and spinal cord - are especially dangerous, as they harm the entire body as a whole and are difficult to treat.

Spina bifida applies specifically to such diseases. Its name is a transcription of the Latin phrase spina bifida - spina bifida.

The Latin name reflects the nature of the pathology - due to a failure during embryonic development The child's vertebrae do not develop as they should. Due to underdevelopment of the vertebrae, the spinal cord and large systems organs.

What it is?

Picture of the course of the disease

Spina bifida occurs in the third week of pregnancy. By this time, the embryo has already completed the formation of the neural tube, the brain and spinal cord, as well as the most important organs and organ systems begin to form.

The formation of the neural tube begins with the formation of the neural groove in the embryo. The edges of the neural groove must then fuse at the top so that the groove closes and the neural tube is formed.

In some cases, the philtrum does not close completely, which leads to the disease spina bifida. The vertebrae in the area of ​​incomplete closure of the neural tube also cannot form correctly. They may be partially or completely split.

In the best case, the vertebrae will lack spinous processes; in the worst case, the vertebrae will be so underdeveloped that the spinal cord will extend beyond the spine. In this case, the nerve fibers are usually located in a skin pouch protruding from the back of the newborn. The anomaly usually affects 3-6, less often 1-2 adjacent vertebrae.

Currently spina bifida can often be corrected and treated. Although in practice this is a very complex process that requires surgery and long-term rehabilitation.

Classification

Depending on the severity, there are three types of spina bifida:

1. Hidden spina bifida or spina bifida occulta. In this form of the disease, the human spinal cord develops absolutely normally. Symptoms can only be detected by x-rays. On x-ray It may be noticeable that some of the vertebrae (most often the lumbosacral spine L5-S1) have gaps or other defects. Basically, the patient does not even feel that he has any pathologies. In very rare cases, patients with spina bifida may experience back and leg pain due to muscle dysfunction. Also, this pathology can lead to diseases of the bladder and intestines and scoliosis. The likelihood of developing any symptoms is reduced by timely detection of hidden spina bifida and the use of a special brace.
2. Meningocele. With this pathology, the spinal cord, which should normally be located in the spinal canal inside the spine, extends beyond its limits. This occurs due to improper development of the vertebrae - they do not completely close the spinal canal. In patients with meningocele, a sac appears on the back, which contains the membranes of the spinal cord - hard, arachnoid and soft. Sometimes the protrusion is covered with skin on top of these membranes. Most often, meningocele appears in the lumbar spine, but it also occurs in the cervical and thoracic spine. This form spina bifida is moderate in severity - the spinal cord is either not damaged at all, or defects of moderate severity develop in it.
3. Myelomeningocele or spina bifida cystica. Three quarters of patients with spina bifida suffer from this, the most severe form of the disease. A so-called cerebral hernia occurs - a protrusion of the spinal cord along with the spinal roots through underdeveloped vertebrae. The hernia may be covered by skin, but sometimes uncovered brain tissue protrudes. The severity of the disease directly depends on the location of the cerebral hernia - the lower the defect is, the less pronounced the symptoms. If the hernia is located closer to the end of the spine, the disease can only result in disruption of the bladder and intestines. If the hernia is located higher, paralysis of the lower extremities may also develop.

ICD disease code

IN international classification spina bifida disease has code Q05 and is located in the section on congenital anomalies. It is characterized as incomplete closure of the spinal canal. At the same time, hidden spina bifida (spina bifida occulta) is located separately in the classification - under the code Q76.0.

Prevalence of the disease

Without taking into account external factors, the probability of having a child with spina bifida is 0.1% -0.2%.

Video: "Spina Bifida - what is it?"

Causes and risk factors

In children

The likelihood of having a child with this anomaly depends on genetic predisposition and external causes.

Risk factors include:

• The presence of spina bifida in one of the parents or already born children.
• Lack of vitamin B9 (folic acid) during pregnancy.
• Alcoholism of the mother, which leads to the breakdown of vitamin B9.
• The use of antiepileptic drugs that contain valproic acid, as they do not allow vitamin B9 to be well absorbed by the body.
• Use of cytostatics (antitumor drugs).
• Diabetes accompanied by obesity, as well as obesity of a non-diabetic nature.
• Transfer viral infection during pregnancy.
• Use of drugs with teratogenic effects.
• Late pregnancy(when a woman is over forty years old).
• Frequent visits to saunas and baths, hot baths.
• Belonging to Caucasian or Hispanic.
• Female sex of the fetus - girls are more often born with spina bifida.

In adults

Spina bifida is a congenital anomaly and cannot develop in an adult.

Consequences and symptoms

Did you know that...

Next fact

In its mildest forms, this disease may not cause any inconvenience to the patient at all.

Sometimes it manifests itself as pain in the back and legs, loss of sensation in some parts of the body, urinary incontinence, poor academic performance and a predisposition to allergic reactions.

In more severe cases, serious bladder and bowel dysfunction.

Unfortunately, most often children are born with the most severe form of spina bifida (myelomeningocele), when the spinal cord is severely and irreversibly damaged.

In this case, severe motor and sensory defects occur, as well as disturbances in the functioning of many organ systems, and unbearable sharp pain is characteristic.

Myelomeningocele is almost impossible to detect in an adult, because people with this anomaly often die in childhood. This type of spina bifida may be accompanied by hydrocephalus, obesity, premature sexual development, deformities of the musculoskeletal system, pathologies of the circulatory and genitourinary systems. Depending on the location of the brain hernia, spina bifida cystica can cause severe congenital disability or be incompatible with life.

Diagnostics

Spina bifida can often be identified during pregnancy.

The following methods are used for this:

1. Ultrasound examination (ultrasound)- most safe method perinatal diagnostics. The disadvantage of the method is that sometimes it is not enough to identify pathology.
2. Blood for biochemical analysis is taken from a vein. The amount of a protein called alpha protein is checked; too much of it can be a sign of a spinal abnormality in the fetus. Sometimes it makes sense to also check the levels of estrogen, estriol and human chorionic gonadotropin. The results of the analysis are confirmed by repeated research.
3. Amniocentesis– taking samples of amniotic fluid with a sterile needle through the abdominal cavity. Puncture of the amniotic bladder threatens to introduce infection into the amniotic fluid and the possibility of miscarriage. This type of study is used if the mother’s blood contains an increased amount of alpha protein, but ultrasonography did not reveal any pathologies.

According to the order of the Ministry of Health dated December 3, 2007 No. 736 “On approval of the list medical indications for artificial termination of pregnancy,” the detection of spina bifida in the fetus can sometimes be a good reason to terminate the pregnancy.

By visually examining a newborn, it is easy to diagnose almost all forms of spina bifida. The latent form is detected using radiography, computed tomography, magnetic resonance imaging, and myelography in adulthood.

Treatment

Spina bifida is, in a certain sense, an incurable disease. All therapeutic measures are aimed only at reducing the manifestation of its symptoms.

Surgery

Treatment of a fetus with spina bifida before birth has become possible only recently, and is still not widespread.

Damage to the integrity of the uterus and amniotic sac threatens serious complications– the appearance of scars on the uterus, infection, premature birth.

In addition, prenatal treatment for this anomaly cannot yet be called effective - almost half of newborns require repeat surgery after birth.

Children with obvious spina bifida they try to perform emergency surgery within 24 hours after birth. The operation is performed by a pediatric neurosurgeon. He reduces the cerebral hernia and covers the spinal cord with membranes.

Sometimes a shunt is also performed - the installation of a tube that should drain excess cerebrospinal fluid into the abdominal cavity. Plastic surgeons help to carefully close the defect with skin.

Other forms of treatment include medication, at home, massage and physical therapy, do not apply.

Prevention

Pregnant women need to know what can lead to dangerous developmental abnormalities in their unborn children. It is very important to follow the recommendations of doctors and visit regularly antenatal clinic and undergo all necessary examinations.

To reduce the likelihood of having a child with spina bifida, pregnant women are advised to eat foods containing folic acid - cereal grains, beans, fruits and vegetables.

:

• Spina bifida disease can manifest itself in completely different ways. The patient may not notice it for years, or may become disabled from birth.
• This is a rare congenital disorder that may occur due to genetic predisposition or lifestyle of the pregnant woman.
• If an anomaly is diagnosed in a child while still in the womb, this may be a reason to terminate the pregnancy. There are methods for treating this pathology before birth, but they are dangerous and ineffective.
• Obvious forms of spina bifida can only be treated surgically.

Spina bifida occulta (hidden vertebral bifida) (Q05) is a congenital moderate pathology of the development of the spine, in which there is no obvious signs malformations. The roots and substance of the spinal cord are not affected, and there is no defect on the back. This form is characterized by the presence of clefts in the vertebrae that form the spine.

Spina bifida occulta is most often located at the lumbosacral level.

Prevalence: 1-2 per 1000 newborns.

Clinical manifestations

This form of pathology usually does not give clinical manifestations and is a radiological finding. But some patients (up to 35%) periodically experience back pain, numbness in the lumbar region, less commonly weakness in the legs (20%), and urination/defecation problems (up to 10%).

An objective examination of the patient can reveal local hypertrichosis, skin pigmentation, capillary hemangiomas, skin changes at the level of the defect (80%). The defect can be palpated in 50% of cases. Reduced sensitivity in the lumbosacral region - 30%. Trophic disorders at the lumbar level - 20%. Pelvic disorders - 10%.

Diagnosis of spina bifida

• X-ray of the lumbosacral spine (detecting a defect in the vertebrae).
• Computer and magnetic resonance imaging of the lumbosacral spine (spina bifida).

X-ray of the lumbosacral spine (defect or gap in the vertebrae that form the spinal column)	Tomography of the lumbosacral spine (spina bifida)

Differential diagnosis:

• Other forms of spinal dysraphism.
• Teratomas of the sacrococcygeal region.
• Myelodysplasia.

Spina bifida treatment

Treatment is symptomatic. Prescribed only after confirmation of the diagnosis by a medical specialist. The presence of increasing spinal symptoms and hydrocephalus is an indication for shunt surgery.

Essential drugs

There are contraindications. Specialist consultation is required.

• (analgesic, anti-inflammatory agent). Dosage regimen: orally, at a dose of 7.5 mg or 15 mg 1 time per day, depending on the intensity of pain.
• (central acting muscle relaxant). Dosage regimen: orally, after meals, without chewing, with a small amount of water. Adults and children over 14 years of age usually start with 50 mg 2-3 times a day, gradually increasing the dose to 150 mg 2-3 times a day.
• (a microcirculation improving agent). Dosage regimen: orally, after meals, without chewing, with a small amount of water, 200 mg (2 tablets) 3 times a day. After achieving a therapeutic effect (usually 1-2 weeks), the dose is reduced to 100 mg (1 tablet) 3 times a day. The maximum daily dose is 1200 mg.
• (vitamin B complex). Dosage regimen: therapy begins with 2 ml intramuscularly 1 time per day for 5-10 days. Maintenance therapy - 2 ml IM two or three times a week.

An anomaly in the development of the spine, which is formed at the stage of uterine development - spina bifida (in Latin called “Spina bifida”). Scientists have found that already in the first month of a mother’s pregnancy, her fetus can develop this disease. What it is? Spina bifida is called spina bifida. The disease can threaten the baby's life with various pathologies. Among them are hernias, spinal malformations, lipomas (), anomalies in the development of the spinal cord, cysts - not fatal dangerous diseases, but requiring special attention and surgical interventions. There is a hidden and obvious form of spina bifida. Every year, almost 2 thousand children in Russia are born with this defect. In most cases, the pathology manifests itself in a complex form.

What is spina bifida

The disease is characterized by abnormal development of the spine, which affects the spinal cord and surrounding nerves. The disease is incurable and accompanies a person throughout his life. Spina bifida in children requires the use of corsets and special devices, which will help to somehow carry out natural life activities, since the disease greatly affects the central nervous system and musculoskeletal system. Spina bifida is divided into types:

1. The disease is of moderate severity.
2. Heavy.

Complex forms chain a person to wheelchair. All that doctors can do is to alleviate the patient’s condition and help him learn to move. People with this diagnosis are born with defects throughout the spine or in any part of it. The lower back is most often affected. Suffering 1 sacral vertebra s1. The arch does not overgrow. At this level, the pathology is not dangerous. In the s1 area it does not develop and does not affect other organs. According to the anatomical canons, in children the sacrum is divided into separate vertebrae, which in adulthood turn into a homogeneous system. Pathology of the lower vertebra lumbar region l5 appears no less often. Almost 85% of cases of defects concern the lower part of the spine, the rest are diagnosed in the cervical and thoracic regions. Involvement of the l5 vertebral region is the most common.

Surgery can restore the integrity of the spine, but the nerves cannot be restored. According to doctors, the closer to the head the defect is located, the more serious the situation.

The most moderate type of spina bifida is hidden. There are no obvious deviations or pathologies, skin are not violated. The diagnosis of “spina bifida” in a latent form is made when one of the vertebrae is damaged and the nerves or spinal cord do not come out. Most often this is vertebra s1 or l5. At birth, a child with such an anomaly clearly shows a depression in the area where the vertebra is split. Sometimes the spinal cord is attached to the vertebra. This is another one of the anomalies. The norm is free sagging of the spinal cord without contact with the spine.

1. Meningocele. Moderate type of illness. In this form, the spinal canal is not closed and surgery is required to bring everything back to normal. In adults, this type of spina bifida causes disturbances in the gastrointestinal tract and urinary system.
2. Lipomeningocele. A more severe manifestation of spina bifida, in which fatty tissue, which normally does not come into contact with the spinal cord, presses on it. In babies, the nerve structures may not be affected, but problems with the gastrointestinal tract are possible. Surgery is indicated.
3. Myelomeningocele. Complex view spina bifida. The canal through which the spinal cord passes is not blocked, and all the contents stick out along with the nerves. In addition to these characteristics, the patient’s skin in this area is deformed. In patients with this type of disease, the peritoneal organs are affected, and complex defects of other systems develop.

The causes of the anomalies are a lack of B vitamins and especially folic acid in the body of a pregnant woman, not only in the initial stages, but also in all trimesters. If a woman takes anticonvulsants, she is at risk for developing spina bifida in her unborn baby. At the initial stage of fetal development, the spine and spinal cord are flat cells, which later fold and turn into the neural tube. If this does not happen or goes away in parts, a terrible disease is evident. Its cause remains unknown, but scientists’ assumptions boil down to conclusions about the confluence of 3 circumstances at once in the formation of the disease: genetic predisposition, poor nutrition during pregnancy and unfavorable environment. Expectant mothers are advised to consume more vitamin B and avoid taking antibiotics.

There is a high risk of developing spina bifida in those babies whose mothers have diabetes. If a pregnant woman is approaching 40 years of age, and this is her first child, when the woman belongs to a socially vulnerable segment of the population, drinks alcohol, and is obese, there is a risk of improper development of the baby in the womb. Doctors warn pregnant women against visiting saunas and using jacuzzi.

Symptoms of the disease depend on the form and its severity.

The following manifestations are distinguished:

1. If the splitting is hidden, there may be no symptoms, or there may be a small spot in the area of ​​pathology.
2. In more severe forms, the symptoms become obvious; the vertebra may protrude and become clearly visible.
3. At complex forms– paralysis of the limbs (mainly the lower ones), disruption of the activity of the peritoneal organs.

Among the deviations in the full development of the body:

• disorders of brain activity - hydrocephalus;
• upward displacement of the medulla toward the cervical vertebra (leading to significant speech impairment);
• underdevelopment of the spinal cord, leading to scoliosis and other spinal diseases;
• early sexual development;
• neuroses;
• excess body weight;
• skin disorders;
• ailments of the cardiac system;
• blurred vision.

The disease is diagnosed during pregnancy using MRI of the spine or CT. Other diagnostic procedures are also carried out. Among them, piercing the fetal spine through the mother’s abdominal cavity in order to collect the substance for laboratory testing. Ultrasound also helps to recognize the disease at the initial stage of a baby’s development. Blood biochemistry is also done according to indicators that determine the presence of the disease.

This study is carried out from 16 to 19 weeks of pregnancy in representatives of the fair sex, in whose family there were such anomalies or who previously gave birth to babies with spina bifida. As soon as a baby with this diagnosis is born, there is a danger of rupture of the wall of the sac in which the hernia is located and infection of neighboring tissues.

Children diagnosed with spina bifida suffer from low back pain or chest pain. They have disorders motor system. Fecal and urinary incontinence is observed. The spine is deformed. Approximately 20% of patients suffer from spina bifida. Even in a wheelchair they cannot move normally. These children are indicated for surgery so that they simply have the opportunity to adapt socially.

Treatment is carried out already at the stage intrauterine development baby. Hernia or other defects are eliminated. But this intervention is done in rare cases. In this way, it is possible to avoid the development of hydrocephalus and other anomalies. These children will be able to move with the condition of subsequent treatment after birth. The technique has not yet found wide application in Russia.

The most common option is to eliminate the disease immediately after birth. It is desirable that it occurs as a result caesarean section. The baby is first operated on and then treated. Caesarean section is necessary to prevent damage to the baby's spine during natural childbirth. The operation is performed on the child on the first day after birth. Surgeons close the bone defect and keep the bone marrow intact. If the structure of the nerves has already been damaged, they cannot be restored.

The main thing is to preserve the baby’s motor function and the ability to normally carry out important vital functions of the body. At the rehabilitation stage, means are used to recover from injury: prostheses, therapeutic exercises and physiotherapeutic procedures are indicated.

In some cases, this is especially likely when a woman was not observed by doctors during pregnancy, the disease is discovered in children by chance, during diagnosis based on complaints. In this case, the result of the MRI analysis will be terrible diagnosis. Doctors take measures to manipulate the spine to prevent damage to the spinal cord. For adults, surgery is performed only if a complication of the disease occurs. In other cases, therapy comes down to prevention. In addition to physical procedures, patients wear a special corset.

Often it is necessary to carry out not one, but several operations at various intervals. It is necessary to eliminate the cerebrospinal fluid or hernia. This depends on the reaction of the little patient’s body to previous interventions. If after this pain appears or the spine is deformed, surgeons come to the conclusion that the spinal cord, despite all efforts, is fixed and adjacent to the vertebrae. The patient undergoes a new operation.

Bifida is a concern for back patients and their relatives future life and its usefulness. Social adaptation possible, according to doctors. The lower the dysfunction was centered on the spine, the more favorable the prognosis.

Today, scientists agree that pathologies of the neural tube of the fetus are the most common. As a preventive measure for women wishing to give birth healthy child, you need to think about your health even before pregnancy.

The main thing is planning. In addition to reception necessary complex vitamins (as prescribed by a doctor), you need to pay attention to a more in-depth examination. Even if a woman’s immediate and distant relatives did not have similar pathologies, it is important to get advice from a geneticist.

It is known that medical scientists some time ago learned to prevent abnormalities of the fetal neural tube. For women who have had such defects in their family, doctors recommend consuming before pregnancy and up to the 3rd trimester. a large number of folic acid. The dosage is prescribed by the doctor in each specific case.

In some European countries, folic acid is recommended for use by all pregnant women without exception. This drug even ended up in mandatory list free medications given to expectant mothers. Thus, the incidence of infant diseases has decreased significantly over the past 5 years. But this technique is not yet practiced in Russia.

Women are advised to eat foods high in folic acid: fruits, vegetables, cereals. Rich in this substance: green salad, green vegetables, spinach, parsley and dill, cabbage, black currants, rose hips, raspberries.

Vegetables: beets, peas, carrots, cucumber. Fruits: bananas, apricots, oranges. From animal products: meat, milk, fish. But saturation with foods rich in vitamin B9 is not enough. It is necessary to take folic acid as medicine as prescribed by the doctor.

Another preventive measure is information. A woman should know why she needs to take certain medications or vitamins during pregnancy, what foods should be included in her diet to prevent the baby from developing spina bifida.