Spina bifida cases drop after team's research

A landmark US-China research study provided the foundation for a public health initiative that has helped to lower the number of cases of the birth defect spina bifida and related neural tube defects in both countries.

Spina bifida occurs when the spinal cord and brain don't develop properly in a fetus. There are related defects that can also develop and they are called neural tube defects (NTD), according to Deborah Kowal, president of Contraceptive Technology Communications in Georgia and executive editor of a reference book called Contraceptive Technology.

"NTD is what the group of researchers in China and the US studied," Kowal said in an interview. "In the US we primarily see spina bifida or what is called anencephaly (absence of a brain). In China there were much more rare forms of the neural tube defects."

Kowal said that in the early part of a pregnancy a fetus is vulnerable. In some cases women have genetic disorders that prevent them from absorbing a proper amount of folic acid that is needed for nerve development.

Folic acid is a vitamin of the B complex and can be found in green vegetables like broccoli and lettuce. It needs to be taken before a woman gets pregnant, through the first trimester and replenished daily, she said.

In 1983 researchers in China and the US met to discuss spina bifida and NTDs. Animal studies at that time indicated that inadequate dietary folic intake may be a factor in spina bifida and NTDs, Kowal said.

"In China and other places in the world at that time many people didn't have adequate access to fresh vegetables," she said.

The study didn't actually begin until 10 years later when researchers from the US and China combined forces to recruit more than 285,000 Chinese women and to follow nearly 250,000 pregnancies in an epidemiological study.

More than 16,000 field staff were involved in running the project, which encountered bureaucratic obstacles and cultural differences. The researchers persevered in a collaboration that led to landmark findings on the role of folic acid in preventing spina bifida.

On March 5, 1996, the US Food and Drug Administration mandated that a wide range of enriched cereal-grain products be fortified with folic acid in the hopes of preventing the occurrence of neural tube defects in babies. The mandate was fully implemented two years later.

In the two decades that have followed, the use of folic acid in preventing spina bifida has proven to be a success, said Kowal.

The Centers for Disease Control and Prevention said that using data from birth-defect tracking systems, researchers have found that since folic acid fortification, about 1,300 babies are born each year without an NTD, who might otherwise have been affected. The birth prevalence of NTDs has decreased by 35 percent in the US since folic acid fortification was required in 1998, the center said.

paulwelitzkin@chinadailyusa.com