Journal of Women's Health Care
Open Access

Importance of Antenatal Folate Supplementation and Neural Tube Defects

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Introduction

A 26 years old pregnant woman (Gravida 2, Abortion 1) presented to Antenatal clinic with 5 months of Amenorrhea for regular checkup. More recently she noticed that there is not as much increase in her womb size corresponding to her gestational period. She informed that no scans were done till now. At 8 weeks gestation of first pregnancy she had a history of abortion. No history of consanguineous marriage. No notable medical and family history of alcohol excess or any dietary restriction. On further questioning she had revealed that she didn’t consume folic acid as per the trimester. On examination general condition is NAD (No abnormality defected) and vitals are stable. The reminder of clinical examination shows a remark that is Fundal height is less than the gestational age [1,2].

Case Discussion

All her blood parameters are with in normal range. Immediately TIFFA scan was performed which showed single, live foetus in cephalic position, placenta in anterior upper segment Grade II umbilical cord showing 2 arteries, 1 vein with gestational age 19 to 20 weeks. But to draw biparietal diameter (BPD) it was noted that foetal skull vault was absent, Frog eye sing seen. Another notable finding is absence of anterior abdominal wall with a mass formed at the site of umbilicus [1-3]. And also noted that spinal card with limbs and rib cage were also absent. Impression of USG is given as multiple fetal anomalies, with Anencephaly and Gastrochisis, Neural tube defects and Polyhydramnios (pol-e-hi-DRAM-nee-os) (Table 1 and Figure 1).

Table 1: Blood parameters.

Figure 1. USG image.

The pros and cons were explained to her and advised her to undergo medical termination of pregnancy. MTP was done, Fetus along with placenta and membranes expelled. Bleeding within normal limits check curettage was done. (Figure 2).

Figure 2. Gestational age 19 to 20 weeks.

Post OP findings uneventful patient improved symptoms and Germodynamically stable. Lab parameters are within normal limits; patient discharged with medication such as antibiotics and antiemetics and advised review after a week. Review scan showed no evidence of retained products of conception. No free fluid in abdomen, no lymphadenopathy [4,5].

Conclusion

Since it is evident that abore case is due to deficiency or womed her about the advantages of intake of folicacid in intake in first trimester and informed about the complication might repeat in future pregnancy if she do not take preconceptional folic acid therapy. Preconceptional usage of folic acid in women of child bearing of reduces rick of neural tube defects. Folic acid supplementation not only prevents NTD but also other ricks such as megatoblastic anemis, abmplio placenta, and intrauternine growth retardation. A dose of 4mg/day is given as prophylaxis in all pregnant women with history of NTD, according to WHO. Government of India is providing folic acid tablets with dose of 500mcg which meets the recommended daily allowance (RDA) of all pregnant women. The ideal prophylactic dose of folic acid is 400mcg which ideally should be given three months before pregnancy but atleast one month before pregnancy and continued till three months after pregnancy. In some countries folic acid fortification is done and made available in foods like pasta, cereals, bread.

References

1. Laurence KM, James N, Miller MH, Tennant GB, Campbell H. Double-blind randomised controlled trial of folate treatment before conception to prevent recurrence of neural-tube defects. Br Med J (Clin Res Ed). 1981;282(6275):1509-1511.
2. Bower C, Stanley FJ. Dietary folate as a risk factor for neural-tube defects: evidence from a case-control study in Western Australia. Med Jof Australia. 1989;150(11):613-9.
3. CDC. AZ. Effectiveness in disease and injury prevention use of folic acid for prevention of spina bifida and other neural tube defects—1983–1991. MMWR Morb Mortal Wkly Rep. 1991;40:513-516.
4. World Health Organization. Guideline: optimal serum and red blood cell folate concentrations in women of reproductive age for prevention of neural tube defects. 2015.
5. Tinker SC, Hamner HC, Qi YP, Crider KS. US women of childbearing age who are at possible increased risk of a neural tube defect-affected pregnancy due to suboptimal red blood cell folate concentrations, National Health and Nutrition Examination Survey 2007 to 2012. Birth Defects Research Part A: Clinical and Molecular Teratology. 2015;103(6):517-26.