Prevention

The only known way to prevent spina bifida and other neural tube defects is for the mother to have adequate folic acid levels before and during early pregnancy. This does not work in all cases, but studies have shown that as many as 70% of cases of severe spina bifida could be prevented by adequate folic acid intake.

Folic acid is essential for life.

• The need for folic acid increases during periods of rapid growth, such as development of a fetus in the womb.
  
  
• Many breakfast cereals and grain products in the United States are now fortified with folic acid.
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• Besides fortified foods, other good sources of folic acid include dark green leafy vegetables (for example, broccoli, spinach, dark green lettuce), egg yolks, beans, whole grains, orange juice, and citrus fruits.
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• The average diet in the United States does not include the recommended level of folic acid.
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It is very important that folic acid levels be adequate from the very beginning of pregnancy, before a woman even knows that she is pregnant. The critical need for folic acid is in the first 4 weeks of pregnancy. Waiting until she knows she is pregnant to start increasing folic acid intake is not good enough. All women who are able to become pregnant should take a folic acid supplement, even if they are not planning to become pregnant. (Half of all pregnancies in the United States are not planned.) The folic acid may be taken alone or as part of a daily multivitamin. 

• Women who do not plan to become pregnant in the near future should take 400 micrograms (mcg) per day. This strength of folic acid is available over the counter without a prescription.
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• Women who plan to become pregnant in the near future and have spina bifida themselves, have had a child with spina bifida, or have had a previous pregnancy affected by spina bifida or another neural tube defect should take 10 times this dose (4000 mcg, or 4 milligrams [mg]) for 1-3 months before becoming pregnant. This higher dose is available only by prescription.
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• Women should not try to get 4000 mcg of folic acid by taking 10 multivitamins every day. The extra amounts of other vitamins could harm the woman and her fetus.
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Studies have suggested that cesarean delivery before labor begins can reduce the severity of paralysis in many babies with spina bifida. Couples who have a prenatal diagnosis of spina bifida for their baby may wish to consider a planned cesarean delivery.