Folate deficiency and neural tube defects
Low folic acid, spina bifida, anencephaly
What it is
Folate (vitamin B9, called folic acid in tablets) helps make healthy blood and the baby’s brain and spine. Low folate causes anaemia. In early pregnancy it can cause neural tube defects, where the baby’s spine or skull does not close properly, as in spina bifida.
Common signs
- In adults: tiredness, pale skin and breathlessness
- Sore, red tongue and mouth sores
- In a newborn: an opening or swelling on the back (spina bifida)
- Spina bifida can cause weak legs, poor bladder control and a large head from fluid
How it is diagnosed
A blood test can show large red cells and low folate. In pregnancy, an ultrasound scan can often see spina bifida. Many cases are first seen at birth.
Tests
- Full blood count — large red cells suggest low folate or B12
- Folate and B12 blood levels — where available
- Pregnancy ultrasound scan (around 18–22 weeks) — can find spina bifida
How food affects it
Folate-rich foods help prevent folate anaemia and are good for everyone. But food alone is not enough to prevent spina bifida. Any woman who may get pregnant should take folic acid tablets as advised by a health worker, from before pregnancy through the first 3 months. The baby’s spine forms in the first month, often before you know you are pregnant.
Food as medicine, alongside your medicine. Food works alongside your medicines, not instead of them. Never stop or change your tablets without talking to your health worker.
Eat often
- Dark leafy greens: ugu, kontomire, sukuma wiki, amaranth, cassava leaves — cook briefly
- Beans, cowpeas, lentils, moi moi and akara
- Groundnuts
- Oranges, avocado, pawpaw and banana
- Eggs
- Bread, flour or maize meal marked ‘fortified with folic acid’
Eat in moderation
- Liver — rich in folate, but eat only small amounts in pregnancy because of its high vitamin A
Avoid or cut down
- Alcohol — lowers folate and harms the baby
- Overcooking greens or throwing away the cooking water — destroys folate
Get help urgently
If a baby is born with an opening on the back, cover it with a clean, damp cloth, keep the baby on its tummy, and go to a hospital at once. See a health worker for tiredness, paleness or breathlessness.
General information, not a diagnosis. Always follow the advice of your health worker.