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AVOID A CONGENITAL ABNORMALITY

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A newborn's risk of developing a congenital abnormality known as spina bifida can be decreased if expectant mothers take multivitamins and do not take unnecessary drugs.

"Pregnant women should be taking multivitamins containing the B vitamin folic acid and only use medications with the knowledge and consent of their obstetrician," said Dr. Irving Fish, director of pediatric neurology at New York University Medical Center.In spina bifida, the bony spine that protects the spinal cord fails to develop properly. As a fetus's spine forms during the early weeks of pregnancy, it normally closes first around the middle of the spinal cord, then at either end.

Often, the base of the spine is not completely enclosed, Fish said. An opening occurs in about 5 to 15 percent of the population, in whom it causes no problems and is detected only on a routine X-ray.

However, if the opening at the lower spinal cord is large enough, the nerves at the base of the spine may be exposed, unprotected and defective.

As a result, the baby may have some paralysis of the legs, bladder and bowel incontinence, and be prone to kidney and bladder infections.

The degree of impairment depends on how much of the spinal cord nerves are defective. While there is no cure for spina bifida - nerve cells cannot be repaired - physical therapy can enhance muscular development.

A recent study compared the incidence of spina bifida and other neural-tube defects in babies of women who took vitamins containing folic acid during the first six weeks of pregnancy with those who did not.

The study found that folic acid decreased the prevalence of neural tube defects from 3.5 per 1,000 births to 0.9 per 1,000.

"This does not mean large doses of folic acid are recommended," Fish stressed. "Rather, pregnant women should obtain the amount of folic acid contained in the standard multivitamin - usually from 200 to 400 micrograms." The prevalence of spina bifida and other birth defects is also higher in babies born to women who take drugs during pregnancy, including alcohol and some prescription medications.

For example, valproic acid (Depakene), a medication used to treat seizures, can produce a higher incidence of spina bifida. "Women taking valproic acid may benefit from genetic counseling before contemplating pregnancy," Fish advised.

Overall, the incidence of spina bifida in the United States has declined over the past 10 years.