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The causes of spina bifida are unknown, although most experts agree that the condition is probably caused by a combination of environmental and genetic factors. A number of risk factors for spina bifida have been identified, which are described below.
Folic acid
The most significant risk factor for spina bifida is having an insufficient intake of folic acid during pregnancy. Folic acid is a vitamin that occurs naturally in some foods, such as leafy vegetables, granary bread and some breakfast cereals. Folic acid tablets are also available form pharmacies, supermarkets and health stores.
Women with a very low intake of folic acid are eight times more likely to give birth to a baby with spina bifida compared with women who take the recommended amount.
Exactly how folic acid helps prevent spina bifida is still uncertain. One theory is that it regulates the formation of genetic material that later proves important in an embryo’s development.
See the Prevention section for more information and advice about folic acid and folic acid supplements.
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Previous pregnancy
If you have previously had a child with spina bifida, there is a slightly higher chance that any other children you have will also have the condition. The risk ranges from 3-8%.
Medication
Two types of medicine (valproic acid and carbamazepine) have been linked to an increased risk of spina bifida. These medicines are both used to treat epilepsy and some mood disorders, such as bipolar disorder and schizophrenia.
The associated risks of valproic acid and carbamazepine are outlined below.
Carbamazepine has about a 2% risk of causing spina bifida.
Sodium valproate, when taken at a daily dose of less than 1,000mg, has about a 5% chance of causing spina bifida.
Sodium valproate, when taken at a daily dose of more than 1,000mg, has about a 9% chance of causing spina bifida.
If carbamazepine and sodium valproate are taken together, there is a risk of just under 9% of spina bifida occurring.
Due to this increased risk, it is recommended that sexually active women who are taking these medicines should always use contraception.
If you are taking valproic acid and/or carbamazepine, and you are planning a pregnancy, speak to your treatment team because alternative medications may be available. Taking folic acid supplements can also help minimise the risk.
Diabetes
Women with diabetes have an increased risk of giving birth to a child with spina bifida. This may be due to the excess amount of glucose in the blood interfering with the child’s development.
The level of risk will depend on the severity of your diabetes. However, it is thought that women with diabetes are between two and eight times more likely to have a child with spina bifida compared with women who do not have diabetes.
Obesity
Women who are obese have an increased risk of giving birth to a child with spina bifida. The more obese you are, the higher the risk. Severely obese women (with a body mass index (BMI) that is greater than 40) are thought to be three times more likely to give birth to a child with spina bifida than women who are a healthy weight.
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