• Contact us
• About us
• A-Z topics
• Symptom Checker
• Service Finder
• Linking to us
• Information partners
• Terms of use
• Privacy

Pregnancy, Birth and Baby is funded by the Australian Government and operated by Healthdirect Australia.

Pregnancy, Birth and Baby is provided on behalf of the Department of Health

Pregnancy, Birth and Baby’s information and advice are developed and managed within a rigorous clinical governance framework. This website is certified by the Health On The Net (HON) foundation, the standard for trustworthy health information.

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.

This information is for your general information and use only and is not intended to be used as medical advice and should not be used to diagnose, treat, cure or prevent any medical condition, nor should it be used for therapeutic purposes.

The information is not a substitute for independent professional advice and should not be used as an alternative to professional health care. If you have a particular medical problem, please consult a healthcare professional.

Except as permitted under the Copyright Act 1968, this publication or any part of it may not be reproduced, altered, adapted, stored and/or distributed in any form or by any means without the prior written permission of Healthdirect Australia.

Support this browser is being discontinued for Pregnancy, Birth and Baby

Support for this browser is being discontinued for this site

• Internet Explorer 11 and lower

We currently support Microsoft Edge, Chrome, Firefox and Safari. For more information, please visit the links below:

• Chrome by Google
• Firefox by Mozilla
• Microsoft Edge
• Safari by Apple

You are welcome to continue browsing this site with this browser. Some features, tools or interaction may not work correctly.

Neural tube defects | March of Dimes

Neural tube defects (NTDs) are birth defects of the brain and spinal cord. NTDs can cause serious problems for babies.

To help prevent NTDs, take a vitamin supplement that has 400 micrograms of folic acid in it every day, even if you’re not trying to get pregnant.

If you’re at high risk for NTDs, take 4,000 micrograms of folic acid every day.

Your risk for having a baby with an NTD is higher if you, your partner or your family members have an NTD, or if you’ve had a baby with an NTD.

Folic acid helps prevent NTDs only if you take it before and in the first weeks of pregnancy.

What are neural tube defects?

Neural tube defects (also called NTDs) are birth defects of the brain and spinal cord. Birth defects are health conditions that are present at birth. They change the shape or function of one or more parts of the body. Birth defects can cause problems in overall health, how the body develops or how the body works.

A baby’s neural tube normally starts out as a tiny, flat ribbon that turns into a tube by the end of the first month of pregnancy. If the tube doesn’t close completely, an NTD can happen. NTDs can cause serious problems for babies, including death.

NTDs happen in about 3,000 pregnancies each year in the United States. Hispanic women are more likely than non-Hispanic women to have a baby with an NTD.

The two most common NTDs are spina bifida and anencephaly. Spina bifida affects about 1,500 babies a year in the United States. If your baby has spina bifida, the tiny bones of the spine don’t close completely, and part of the spinal cord pokes through the spine. Children with spina bifida may have paralyzed legs (not able to move) and problems controlling their bladder and bowel (going to the bathroom). Milder forms of spina bifida may cause fewer problems for children.

Anencephaly is one of the most severe NTDs. It affects about 1,000 babies each year in the United States. Anencephaly is caused when the upper part of the neural tube that forms the brain doesn’t close completely. Babies with this condition are missing major parts of the brain, skull and scalp. They do not survive long after birth, usually for just a few hours. Girls are 3 times more likely than boys to have anencephaly.

Taking folic acid before and during early pregnancy can help prevent NTDs in your baby. Folic acid is a B vitamin that every cell in your body needs for normal growth and development.

What causes NTDs?

We’re not exactly sure what causes NTDs. Experts think some may be caused by genetics. This means an NTD can be passed from parents to children through genes. Genes are part of your body’s cells that stores instructions for the way your body grows, looks and works.

NTDs also may be caused by things in your environment, which includes where you live, where you work, the kinds of foods you eat or have access to and how you like to spend your time. Some things in your environment can be harmful to a pregnancy, like certain drugs, cigarette smoke, air pollution and lead.

Are you at risk for having a baby with an NTD?

Any woman can have a baby with an NTD. But there are things that may make you more likely than other women to have a baby with an NTD. These are called risk factors.

 Your risk for having a baby with an NTD is higher if:

• You’ve had a baby with an NTD. If you’ve had a baby with an NTD, there’s a 2- to 3-percent chance of having a baby with an NTD in another pregnancy. A genetic counselor can help you understand your risk for having a baby with an NTD. This is someone who is trained to help you understand medical conditions that run in families, and how they can affect your health and your baby’s health.
• You or your partner has an NTD, your partner has a child with an NTD or someone in either of your families has an NTD. This means you have a family history of NTDs. Use the March of Dimes Family Health History Form to keep track of health conditions, including NTDs,that may run in your family. Fill it out and share it with your health care provider or genetic counselor.

Other risk factors for NTDs include:

• Taking certain anti-seizure medicines. Talk to your health care provider before you get pregnant about how the medicine may affect your pregnancy.
• Obesity. Some studies show that being obese increases your risk for having a baby with an NTD. If you’re obese, you have an excess amount of body fat and your body mass index (BMI) is 30 or higher. To find out your BMI, go to cdc.gov/bmi. Talk to your provider about getting to a healthy weight before pregnancy.
• Diabetes. If your diabetes is uncontrolled, you may be at increased risk for having a baby with an NTD. Eating healthy foods and being active every day can help you keep your diabetes under control.
• Using opioids in the first 2 months of pregnancy. Opioids are highly addictive drugs. Your provider may prescribe an opioid to you as a painkiller if you’ve been injured or had surgery. Common prescription opioids include codeine, hydrocodone and oxycodone. These often are sold and used illegally. If you take any opioid during pregnancy, it can cause serious problems for your baby, like premature birth and drug withdrawal called neonatal abstinence syndrome (also called NAS). If you’re pregnant and taking any drug or medicine that may be an opioid, tell your health care provider right away.
• A high body temperature early in pregnancy. This may be caused by a fever or by spending a lot of time in a hot tub or sauna. If you’re pregnant, stay out of hot tubs and saunas. If you do use them, limit the time to less than 10 minutes.

How can you help prevent NTDs in your baby?

Taking folic acid before and during early pregnancy can help prevent NTDs in your baby. NTDs happen in the first month of pregnancy, before you may know you’re pregnant. This is why it’s important to have enough folic acid in your body before you get pregnant.

Most women

To help prevent NTDs in your baby, take a vitamin supplement with 400 mcg of folic acid every day before getting pregnant. A supplement is a product you take to make up for certain nutrients that you don’t get enough of in the foods you eat. Start taking this amount of folic acid each day at least 1 month before pregnancy and through the first 12 weeks of pregnancy. Your folic acid supplement can be:

• A multivitamin. This is a pill that contains many vitamins and other nutrients that help your body stay healthy.
• A prenatal vitamin. This is a multivitamin that has nutrients you need during pregnancy. Your health care provider may give you a prescription for prenatal vitamins, or you can get them over the counter without a prescription.
• A supplement that contains just folic acid

Take a vitamin supplement with 400 mcg of folic acid each day, even if you’re not trying to get pregnant.

Women at high risk for NTDs

If you’re at high risk for having a baby with an NTD, it’s recommended you take 4,000 mcg of folic acid each day to help prevent an NTD. Start taking 4,000 mcg 3 months before you get pregnant through 12 weeks of pregnancy. You’re at high risk if:

• You’ve had a pregnancy with an NTD in the past.
• You or your partner has an NTD.
• Your partner has a child with an NTD.

Studies show that taking 4,000 mcg of folic acid before and during early pregnancy can help reduce your risk of having another baby with an NTD by about 70 percent. Ask your provider how to safely get this much folic acid. It’s not safe to take several multivitamins or prenatal vitamins because you can get too much of other nutrients, which may be harmful to your health. Your provider can help you figure out the best and safest way for you to get the right amount of folic acid.

Can you get folic acid from food?

Yes! You can get folic acid from foods that are fortified with folic acid. Fortified means a food has folic acid added to it. Check the product label to see how much folic acid you get in each serving. Look for the word “fortified” or “enriched” on labels on foods like: 

• Bread
• Breakfast cereal
• Cornmeal
• Flour
• Pasta
• Products made from a kind of flour called corn masa, like tortillas, tortilla chips, taco shells, tamales and pupusas
• White rice

Some fruits and vegetables are good sources of folic acid. When folic acid is naturally in a food, it’s called folate. Foods that are good sources of folate are:

• Beans, like lentils, pinto beans and black beans
• Leafy green vegetables, like spinach and Romaine lettuce
• Asparagus
• Broccoli
• Peanuts (But don’t eat them if you have a peanut allergy.)
• Citrus fruits, like oranges and grapefruit
• Orange juice (100 percent juice is best. This means one serving of juice is equal to one serving of fruit.)

It’s hard to get all the folic acid you need from food. Even if you eat foods that have folic acid in them, take your vitamin supplement each day, too.

Can you find out if your baby has an NTD before birth?

Yes. You can get prenatal tests (medical tests you get during pregnancy) called screening tests to find out if your baby is at increased risk of having an NTD. Screening tests for NTDs include:

• Maternal blood screening (also called a quad screen). It’s called a quad screen because it measures four substances in your blood. The test is done between 15 to 22 weeks of pregnancy. 
• Ultrasound. This test uses sound waves and a computer screen to show a picture of your baby inside the womb. You usually get an ultrasound at 16 to 20 weeks of pregnancy.

If a screening test shows an increased risk of NTDs, your provider may recommend a diagnostic test to find out for sure if your baby has an NTD. Diagnostic tests for NTDs include:

• Amniocentesis. In this test, your provider takes some amniotic fluid from around your baby in the uterus (womb) to check for birth defects, like NTDs, in your baby. You can get this test at 15 to 20 weeks of pregnancy.
• Detailed ultrasound of your baby’s skull and spine

If you find out that your baby has an NTD, talk to your health care provider to learn more about your baby’s condition and options for birth and treatment. For example:

• You can plan to have your baby in a hospital that specializes in caring for babies with NTDs. This way your baby can have any necessary surgery or treatment soon after birth.
• You can decide whether to have a vaginal or cesarean birth (also called c-section). During vaginal birth, the uterus contracts to help push the baby out through the vagina. A c-section is surgery in which your baby is born through a cut that your doctor makes in your belly and uterus. In some cases, a c-section may be safer for you and your baby than vaginal birth.
• If your baby has spina bifida, you can find out about surgery for your baby in the womb before birth. Surgery to repair spina bifida in the womb before birth is more effective than surgery after birth.

For more information

American Academy of Pediatrics

Spina Bifida Association

Centers for Disease Control and Prevention

Last reviewed: February, 2022

Diagnosis of congenital malformations of the fetus.

Diagnosis of congenital malformations of the fetus is included in the list of mandatory tests conducted by a woman during pregnancy. And this is no coincidence, because intrauterine fetal malformations are one of the main causes of perinatal mortality and disability in children.

There can be many reasons for intrauterine development defects in a child. Pathology is sometimes hereditary, its causes can be negative external and internal factors. There is only one result - a terrible blow for the whole family, which not everyone manages to withstand with dignity, and this despite the fact that today in Russia 5 out of 100 children are born with similar problems.

What intrauterine fetal malformations can be detected already during pregnancy?

• Down syndrome or trisomy on the 21st pair of chromosomes, which subsequently leads to multiple malformations of internal organs and mental retardation.
• Edwards syndrome or trisomy for the 18th pair of chromosomes, characterized by malformations of many internal organs.
• Malformations of the neural tube, manifested by the absence of the brain (anencephaly), defects in the fusion of the spinal canal and the formation of a hernia of the spinal cord (spina bifida).
• Malformations of the heart and lungs.
• Malformations of limbs.
• Malformations of the facial part of the skull, e.g. cleft palate, cleft lip, etc.

Prenatal diagnosis of intrauterine malformations of a child is carried out in two main stages, including ultrasound and blood tests.

For the first time, a woman should visit an ultrasound room at 10-14 weeks of gestation, which allows you to confirm the presence of pregnancy; find out if the pregnancy is uterine or ectopic; determine the gestational age with an accuracy of 2-3 days; identify multiple pregnancies; exclude false pregnancy and pronounced anatomical abnormalities. And most importantly, there are signs of chromosomal anomalies of Down syndrome, which may not manifest themselves later, the definition of which largely depends on the qualifications of the doctor and the level of ultrasound equipment.

Blood test:

• b-hCG or free b-subunit of chorionic hormone.
• PAPP-A protein or pregnancy-associated plasma protein.

If deviations in the development of the fetus are detected, then at a period of 16-18 weeks of pregnancy, a triple biochemical test is performed, taking into account the results of the first screening and including:

• blood test for alpha-fetoprotein;
• blood test for free estriol;
• blood test for b-hCG.

Ultrasound examination at 20-24 weeks of gestation reveals the compliance of fetal development with the expected gestational age; diagnosis of fetal malformations; recommendations are given on the continuation of pregnancy (or its termination if severe anomalies in the development of the fetus are detected). In this period, all organs are fully formed, it is possible to assess their structure and, indirectly, function. Each organ of the fetus is examined in detail. When examining the head, the shape and thickness of the bones of the skull, the structure of the brain, its hemispheres, subcortical formations, the cerebellum and the ventricles of the brain are assessed. The structure of the facial skull and soft tissues of the face is analyzed. Vertebral defects (hernia and curvature, absence of vertebrae) are excluded. The shape and size of the chest, ribs, and shoulder blades are assessed. Examine the region of the anterior abdominal wall to exclude an umbilical hernia. Then the arms and legs of the unborn child are examined, assessing the movements in the joints, the length and thickness of the tubular bones. In this period of pregnancy, the heart of the fetus is especially carefully examined. At the same time, most serious heart defects are diagnosed, including those incompatible with life or requiring surgical treatment in the early stages after the birth of a child. Other internal organs of the fetus are being studied, which are already practically formed and available for research. These are the lungs, intestines, spleen, stomach, liver and gallbladder, kidneys and bladder. Again, chromosomal markers and the risk of chromosomal pathology are excluded. An ultrasound examination of the placenta, umbilical cord, amniotic fluid is carried out, the features of the body, cervix and its appendages are evaluated.

Ultrasound at 30-34 weeks can reveal the possible presence of fetal growth retardation syndrome; to identify possible fetal pathologies that were not detected for one reason or another at earlier stages of pregnancy; determine the amount of amniotic fluid. The body parts of the fetus (head, chest, limbs) are measured to assess its height, weight and proportions. These measurements make it possible to exclude fetal growth retardation. By the 28th week, the cheeks of the fetus are rounded, the face becomes more formed, lips and nose are distinguishable. He can scratch his ear, fold his fists, yawn, make a grimace, smile.

In early pregnancy, blood flow in the uterine arteries is measured to identify pregnant women at high risk of preeclampsia in the second half of pregnancy and fetal growth retardation. This study also helps in the management of pregnant women with diabetes and vascular disorders.

According to the results of ultrasound, at all stages of pregnancy, recommendations are given for the management of pregnancy. In the event of a pathology, women must consult with the leading specialists of the regional Perinatal Center, the diagnosis of the chromosome set of the fetus is carried out. If necessary, the woman is sent to the city, regional perinatal council to determine the subsequent tactics of managing the pregnant woman and future examination of the child.

Group at risk of intrauterine anomalies

High risk of intrauterine anomalies are:

Remember! The earlier the pathology is detected, the more chances the doctor has to correct the "mistake of nature", intervene in the course of pregnancy, thoroughly prepare the mother and child for childbirth and subsequent treatment.

Chief physician of the Tet-a-Tet medical center, obstetrician-gynecologist, doctor of the highest category Ulyanova Saniya Muzagitovna.

Neural tube formation and malformations

The process of neural tube formation is called neurulation. Neurulation of begins with the appearance of the neural plate, which invaginates into the spine to form a neural network with neural grooves on either side of the spine. Gradually, the neural grooves approach each other along the midline of the spine and merge, thus transforming the neural grooves into a neural tube.

Neural tube formation begins in the region of the future neck at the level of the 4th somite (4 segments of the cervical spine). Neurulation begins 16 days after fertilization and ends on days 21-22. Neurulation in humans occurs in several stages. First, the dorsal section of the spine closes, then the closure occurs in the area from the forehead to the parietal tubercles, the third stage closes the facial section of the skull, then the section from the occipital lobes to the cervical spine, and the last stage closes the sacral section.

At neurulation disorders at the stages of neural tube closure, congenital malformations are detected, such as:

• anencephaly (congenital absence or underdevelopment of the brain and cerebellum),
• spina bifida - Spina Bifida,
• exencephaly (absence of skull bones)

and other defects of the central nervous system. Neural tube closure defects are quite rare. With severe defects in the development of the neural tube, such as anencephaly, spina bifida, the fetus dies in the womb or is born non-viable and dies in the coming days after birth. Modern equipment helps to detect neural tube malformations at regular check-ups during pregnancy. With early diagnosis of malformations of the neural tube, termination of pregnancy is indicated.

The formation of the human neural tube is a complex interaction between genetic and environmental factors. Some genes are important for neural tube formation, but dietary factors such as cholesterol and folic acid levels are also important for proper neural tube formation.

Learn more

• 
  How to make an angel costume for a child
• 
  How is measles treated
• 
  How to prepare your child for tooth extraction
• 
  How do you know if your sperm is healthy
• 
  What babies do in the womb
• 
  How many calories should a 10 year old child eat
• 
  Pate in pregnancy
• 
  How to stop a child from playing with poop
• 
  Miscarriage but still pregnant
• 
  How does technology affect child development
• 
  How young can you put a child in daycare