Written by Tan Pei Yee

Have you wonder why women need to take folic acid during pregnancy, or even earlier before getting pregnant? One of the reasons being is folic acid can help to prevent some major birth defects, such as spina bifida.

The term spina bifida comes from Latin and it literally means “split” or “open” spine. This defect happens when the neural tube (an embryonic structure that eventually forms the baby’s brain and spinal cord) fails to develop or close properly, causing the backbone that protects the spinal cord does not form and close as it should. Depending on the size, location, types of defect and complications caused, spina bifida can range from mild to severe.

Generally, there are three types of spina bifida.

Spina Bifida Occulta (SBO) 

The most common and mildest type of defect is spina bifida occulta (SBO). The word “occulta” means “hidden”, showing that the defect is covered by skin and many people are unaware of it. Although there might be a small gap in spine or a tuft of hair or a birthmark shown on the skin at the part of defect, the spinal cord and nerve are usually not affected and normally will not cause any disabilities.



This rare type of spina bifida occurs when the meninges push through the hole in the skull or vertebrae, creating a fluid-filled sac which is visible on the baby’s head, neck or back. The sac is usually covered by a thin layer of skin and might be as big as a grapefruit or as small as a grape. As the spinal cord is not in the sac, meningocele usually cause little or no nerve damage. However, it might lead to some minor disabilities, such as bowels and urinary incontinence.


This is the most severe form of spina bifida. A sac of fluid pokes out at the baby’s back and part of the spinal cord and nerves are involved in this sac and those parts get damaged. Sometimes, the sac bursts during childbirth, causing the nerve and spinal cord being exposed, leading to life-threatening infections. A baby with myelomeningocele will usually have paralysis and muscle or bone problems.

No one knows the exact causes of spina bifida. However, scientists believe that there are numbers of factor which may increase the risk of developing spina bifida.

These include:

  • Low intake of folic acid during pregnancy
  • Having family history of spina bifida
  • Taking certain medications during pregnancy, such as anti-seizure medicines like valproic acid
  • Diabetes
  • Obesity
  • Increased body temperature during early pregnancy


We could not guarantee that folic acid can help to avoid the occurrence of spina bifida, but studies have shown that taking folic acid starting at least one month before conception and continuing throughout the first trimester greatly reduced the risk of developing spina bifida. The recommended dosage taking is at least 400 micrograms of folic acid every day, depending on the risks associated. Folic acid can also be found in food such as dark green leafy vegetables, egg yolks, orange juice and some fortified breads, pastas, rice and breakfast cereals. This is the way to give the best protection to the unborn baby.