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Spina bifida is a birth defect where the spine and spinal cord do not form properly, leaving a gap in the vertebrae. It is one of the most common severe birth defects, affecting around 1,500-2,000 babies each year in the US. There are three main types ranging from mild to severe. The most severe type is myelomeningocele which can cause paralysis and neurological problems. The exact causes are unknown but risk factors include family history, folic acid deficiency, obesity, diabetes, and certain medications. Detection methods include blood tests, ultrasound, and amniocentesis. Management involves early surgery, antibiotics to prevent infection, physical therapy, and assistive devices. Taking 400 micrograms

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SPINA BIFIDASPINA BIFIDA DR BLUOGADR BLUOGA
Spina BifidaSpina Bifida
Spina BifidaSpina Bifida The human nervous system develops from aThe human nervous system develops from a small, specialized plate of cells along the back ofsmall, specialized plate of cells along the back of an embryo.an embryo. Early in development, the edges of this plateEarly in development, the edges of this plate begin to curl up toward each other, creating thebegin to curl up toward each other, creating the neural tube—a narrow sheath that closes to formneural tube—a narrow sheath that closes to form the brain and spinal cord of the embryo.the brain and spinal cord of the embryo. the top of the tube becomes the brain and thethe top of the tube becomes the brain and the remainder becomes the spinal cord.remainder becomes the spinal cord.
This process is usually complete by theThis process is usually complete by the 28th day of pregnancy.28th day of pregnancy. But if problems occur during this process,But if problems occur during this process, the result can be brain disorders calledthe result can be brain disorders called neural tube defectsneural tube defects, including, including spinaspina bifidabifida..
Developmental Biology – 6th ed.
What is spina bifida?What is spina bifida? Spina bifida, which literally means “cleft spine,”Spina bifida, which literally means “cleft spine,” is characterized by the incomplete developmentis characterized by the incomplete development of the brain, spinal cord, and/or meninges.of the brain, spinal cord, and/or meninges. Spina bifida is one of the more common birthSpina bifida is one of the more common birth defects in the United States.defects in the United States. It is among the most common severe birthIt is among the most common severe birth defects in the United States, affecting 1,500 todefects in the United States, affecting 1,500 to 2,000 babies (one in every 2,000 live births)2,000 babies (one in every 2,000 live births) each year.each year.
the different types of spina bifidathe different types of spina bifida OccultaOcculta: is the mildest and most common: is the mildest and most common form in which one or more vertebrae areform in which one or more vertebrae are malformed.malformed. The name “occulta,” which meansThe name “occulta,” which means “hidden,” indicates that the malformation,“hidden,” indicates that the malformation, or opening in the spine, is covered by aor opening in the spine, is covered by a layer of skin.layer of skin. This form of spina bifida rarely causesThis form of spina bifida rarely causes disability or symptoms.disability or symptoms.
OccultaOcculta
meningocelemeningocele ::the meninges protrudethe meninges protrude from the spinal opening, and thefrom the spinal opening, and the malformation may or may not be coveredmalformation may or may not be covered by a layer of skinby a layer of skin.. Some patients with meningocele maySome patients with meningocele may have few or no symptoms while othershave few or no symptoms while others may experience symptoms similar tomay experience symptoms similar to closed neural tube defects.closed neural tube defects.
meningocelemeningocele
MyelomeningoceleMyelomeningocele :is the most severe:is the most severe and occurs when the spinal cord isand occurs when the spinal cord is exposed through the opening in the spine,exposed through the opening in the spine, resulting in partial or complete paralysis ofresulting in partial or complete paralysis of the parts of the body below the spinalthe parts of the body below the spinal opening.opening. The paralysis may be so severe that theThe paralysis may be so severe that the affected individual is unable to walk andaffected individual is unable to walk and may have urinary and bowel dysfunction.may have urinary and bowel dysfunction.  
MyelomeningoceleMyelomeningocele
Spina bifida group
What causes spina bifida?What causes spina bifida? The exact cause of spina bifida remains aThe exact cause of spina bifida remains a mystery.mystery. No one knows what disrupts complete closure ofNo one knows what disrupts complete closure of the neural tube, causing a malformation tothe neural tube, causing a malformation to develop.develop. Scientists suspectScientists suspect genetic, nutritional, andgenetic, nutritional, and environmental factorsenvironmental factors play a role.play a role. it appears to result from a combination ofit appears to result from a combination of genetic and environmental risk factors, such asgenetic and environmental risk factors, such as a family history of neural tube defects, folic acida family history of neural tube defects, folic acid deficiency and medical conditions such asdeficiency and medical conditions such as diabetes and obesity.diabetes and obesity.
Risk factorsRisk factors Race.Race. Spina bifida is more common among HispanicsSpina bifida is more common among Hispanics and whites of European descent.and whites of European descent. Family history of neural tube defects.Family history of neural tube defects. Couples who'veCouples who've had one child with a neural tube defect have a slightlyhad one child with a neural tube defect have a slightly higher chance of having another baby with the samehigher chance of having another baby with the same defect. That risk increases if two previous children havedefect. That risk increases if two previous children have been affected by the condition. In addition, a woman whobeen affected by the condition. In addition, a woman who was born with a neural tube defect, or who has a closewas born with a neural tube defect, or who has a close relative with one, has a greater chance of giving birth torelative with one, has a greater chance of giving birth to a child with spina bifida. However, most babies witha child with spina bifida. However, most babies with spina bifida are born to parents with no known familyspina bifida are born to parents with no known family history of the condition.history of the condition.
Folic acid deficiency.Folic acid deficiency. This vitamin is importantThis vitamin is important to the healthy development of a fetus. Lack ofto the healthy development of a fetus. Lack of folic acid (vitamin B-9) increases the risk offolic acid (vitamin B-9) increases the risk of spina bifida and other neural tube defects.spina bifida and other neural tube defects. Some medications.Some medications. Anti-seizure medications,Anti-seizure medications, such as valproic acid (Depakene), seem tosuch as valproic acid (Depakene), seem to cause neural tube defects when taken duringcause neural tube defects when taken during pregnancy, perhaps because they interfere withpregnancy, perhaps because they interfere with the body's ability to use folic acid.the body's ability to use folic acid.
Diabetes.Diabetes. The risk of spina bifida increases withThe risk of spina bifida increases with diabetes, especially when the mother's blooddiabetes, especially when the mother's blood sugar is elevated early in her pregnancy. Muchsugar is elevated early in her pregnancy. Much of this risk is preventable by careful blood sugarof this risk is preventable by careful blood sugar control and management.control and management. Obesity.Obesity. There's a link between pre-pregnancyThere's a link between pre-pregnancy obesity and neural tube birth defects, includingobesity and neural tube birth defects, including spina bifida. Obese women may have morespina bifida. Obese women may have more babies with spina bifida possibly because ofbabies with spina bifida possibly because of nutritional deficits from poor eating habits ornutritional deficits from poor eating habits or because they may have diabetes.because they may have diabetes.
Increased body temperature.Increased body temperature. SomeSome evidence suggests that increased bodyevidence suggests that increased body temperature (hyperthermia) in the earlytemperature (hyperthermia) in the early months of pregnancy may increase themonths of pregnancy may increase the risk of spina bifida.risk of spina bifida.
Factors that affect the severity of complicationsFactors that affect the severity of complications include:include: The size and location of the neural tube defect .The size and location of the neural tube defect . Whether skin covers the affected areaWhether skin covers the affected area Whether spinal nerves come out of the affectedWhether spinal nerves come out of the affected area of the spinal cord.area of the spinal cord. Children with myelomeningocele mayChildren with myelomeningocele may experience physical and neurological problems,experience physical and neurological problems, including lack of normal bowel and bladderincluding lack of normal bowel and bladder control, and partial or complete paralysis of theircontrol, and partial or complete paralysis of their legs.legs.
Babies born with myelomeningocele alsoBabies born with myelomeningocele also commonly experience accumulation of fluid incommonly experience accumulation of fluid in the brain, a condition known as hydrocephalus.the brain, a condition known as hydrocephalus. Most babies with myelomeningocele will need aMost babies with myelomeningocele will need a shunt .shunt . The majority of newborns withThe majority of newborns with myelomeningocele survive.myelomeningocele survive. some may develop meningitis, an infection in thesome may develop meningitis, an infection in the tissues surrounding the braintissues surrounding the brain
Children with myelomeningocele mayChildren with myelomeningocele may develop learning disabilities.develop learning disabilities. Children with spina bifida may also sufferChildren with spina bifida may also suffer from latex allergies, skin problems, urinaryfrom latex allergies, skin problems, urinary tract infections, gastrointestinal disorders,tract infections, gastrointestinal disorders, seizure disorders, depression, and socialseizure disorders, depression, and social and emotional problems.and emotional problems.
Screening and diagnosisScreening and diagnosis (1)Blood tests(1)Blood tests second trimester maternal serum alphasecond trimester maternal serum alpha fetoprotein (MSAFP)fetoprotein (MSAFP) alpha-fetoproteinalpha-fetoprotein (AFP) is made naturally by the(AFP) is made naturally by the fetus and placenta.fetus and placenta. But if abnormally high levels of this proteinBut if abnormally high levels of this protein appear in the mother’s bloodstream it mayappear in the mother’s bloodstream it may indicate that the fetus has a neural tube defect.indicate that the fetus has a neural tube defect. The MSAFP test, however, is not specific forThe MSAFP test, however, is not specific for spina bifida.spina bifida.
UltrasoundUltrasound: An advanced ultrasound can also detect: An advanced ultrasound can also detect signs of spina bifida.signs of spina bifida. AmniocentesisAmniocentesis An analysis indicates the level of AFP present in theAn analysis indicates the level of AFP present in the amniotic fluid.amniotic fluid. A small amount of AFP is normally found in amnioticA small amount of AFP is normally found in amniotic fluid.fluid. when an open neural tube defect is present, the amnioticwhen an open neural tube defect is present, the amniotic fluid contains an elevated amount of AFP because thefluid contains an elevated amount of AFP because the skin surrounding the baby's spine is gone and AFP leaksskin surrounding the baby's spine is gone and AFP leaks into the amniotic sac.into the amniotic sac. MRIMRI
How can spina bifida be managed? - Detection - Antibiotics - Surgery - Careful observation - Physical therapy
How can spina bifida be managed? -Detection -Triple screening -Maternal blood test for α-fetoprotein -Ultrasound for bone defects -Amniocentesis - α-fetoprotein is elevated in 75-80% of cases of spina bifida (myelomeningocele)
Amniocentesis – using a needle to collect amniotic fluid How can spina bifida be managed?
How can spina bifida be managed? -Antibiotics - In some cases the spinal cord is exposed to the environment - Antibiotics are essential in preventing infection of the CNS
How can spina bifida be managed? -Surgery - In some cases the spinal cord is exposed to the environment or tethered - Surgery is performed in order to cover the spinal cord with muscle and skin or to untether the spinal cord - in utero surgery has also become a
Early surgery on the spinal cord may allow theEarly surgery on the spinal cord may allow the child to regain a normal level of functioning andchild to regain a normal level of functioning and prevent further neurological deterioration.prevent further neurological deterioration. Some children will need subsequent surgeries toSome children will need subsequent surgeries to manage problems with themanage problems with the feet, hips, or spinefeet, hips, or spine.. Individuals withIndividuals with hydrocephalushydrocephalus generally willgenerally will require additional surgeries to replace therequire additional surgeries to replace the shuntshunt Some individuals with spina bifida requireSome individuals with spina bifida require assistive devices such asassistive devices such as braces, crutches, orbraces, crutches, or wheelchairswheelchairs. The. The location of thelocation of the malformationmalformation on the spine often indicates theon the spine often indicates the type of assistive devices needed.type of assistive devices needed.
How can spina bifida be managed? - Careful Observation - Children with myelomeningocele often have hydrocephalus (blockage of CSF) - Children may present with paralysis, blindness, MR, inability to speak, convulsions -Any changes in mental status or behavior should be quickly brought to the attention of the child’s physician(s)
How can spina bifida be managed? - Physical Therapy - Spinal cord damage can cause muscle weakening and wasting - Speech therapy may also be useful for some individuals
PreventionPrevention Folic acid is an important vitamin in theFolic acid is an important vitamin in the development of a healthy fetus.development of a healthy fetus. Recent studies have shown that by adding folicRecent studies have shown that by adding folic acid to their diets, women of childbearing ageacid to their diets, women of childbearing age significantly reduce the risk of having a child withsignificantly reduce the risk of having a child with a neural tube defect, such as spina bifida.a neural tube defect, such as spina bifida. Dosage:400 micrograms of folic acid dailyDosage:400 micrograms of folic acid daily Foods high in folic acid include dark greenFoods high in folic acid include dark green vegetables, egg yolks, and some fruits.vegetables, egg yolks, and some fruits.
prognosisprognosis Prognosis depends on the number andPrognosis depends on the number and severity of abnormalities and associatedseverity of abnormalities and associated complications.complications.
COMFUSINGCOMFUSING

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Spina bifida group

  • 1. SPINA BIFIDASPINA BIFIDA DR BLUOGADR BLUOGA
  • 3. Spina BifidaSpina Bifida The human nervous system develops from aThe human nervous system develops from a small, specialized plate of cells along the back ofsmall, specialized plate of cells along the back of an embryo.an embryo. Early in development, the edges of this plateEarly in development, the edges of this plate begin to curl up toward each other, creating thebegin to curl up toward each other, creating the neural tube—a narrow sheath that closes to formneural tube—a narrow sheath that closes to form the brain and spinal cord of the embryo.the brain and spinal cord of the embryo. the top of the tube becomes the brain and thethe top of the tube becomes the brain and the remainder becomes the spinal cord.remainder becomes the spinal cord.
  • 4. This process is usually complete by theThis process is usually complete by the 28th day of pregnancy.28th day of pregnancy. But if problems occur during this process,But if problems occur during this process, the result can be brain disorders calledthe result can be brain disorders called neural tube defectsneural tube defects, including, including spinaspina bifidabifida..
  • 6. What is spina bifida?What is spina bifida? Spina bifida, which literally means “cleft spine,”Spina bifida, which literally means “cleft spine,” is characterized by the incomplete developmentis characterized by the incomplete development of the brain, spinal cord, and/or meninges.of the brain, spinal cord, and/or meninges. Spina bifida is one of the more common birthSpina bifida is one of the more common birth defects in the United States.defects in the United States. It is among the most common severe birthIt is among the most common severe birth defects in the United States, affecting 1,500 todefects in the United States, affecting 1,500 to 2,000 babies (one in every 2,000 live births)2,000 babies (one in every 2,000 live births) each year.each year.
  • 7. the different types of spina bifidathe different types of spina bifida OccultaOcculta: is the mildest and most common: is the mildest and most common form in which one or more vertebrae areform in which one or more vertebrae are malformed.malformed. The name “occulta,” which meansThe name “occulta,” which means “hidden,” indicates that the malformation,“hidden,” indicates that the malformation, or opening in the spine, is covered by aor opening in the spine, is covered by a layer of skin.layer of skin. This form of spina bifida rarely causesThis form of spina bifida rarely causes disability or symptoms.disability or symptoms.
  • 9. meningocelemeningocele ::the meninges protrudethe meninges protrude from the spinal opening, and thefrom the spinal opening, and the malformation may or may not be coveredmalformation may or may not be covered by a layer of skinby a layer of skin.. Some patients with meningocele maySome patients with meningocele may have few or no symptoms while othershave few or no symptoms while others may experience symptoms similar tomay experience symptoms similar to closed neural tube defects.closed neural tube defects.
  • 11. MyelomeningoceleMyelomeningocele :is the most severe:is the most severe and occurs when the spinal cord isand occurs when the spinal cord is exposed through the opening in the spine,exposed through the opening in the spine, resulting in partial or complete paralysis ofresulting in partial or complete paralysis of the parts of the body below the spinalthe parts of the body below the spinal opening.opening. The paralysis may be so severe that theThe paralysis may be so severe that the affected individual is unable to walk andaffected individual is unable to walk and may have urinary and bowel dysfunction.may have urinary and bowel dysfunction.  
  • 14. What causes spina bifida?What causes spina bifida? The exact cause of spina bifida remains aThe exact cause of spina bifida remains a mystery.mystery. No one knows what disrupts complete closure ofNo one knows what disrupts complete closure of the neural tube, causing a malformation tothe neural tube, causing a malformation to develop.develop. Scientists suspectScientists suspect genetic, nutritional, andgenetic, nutritional, and environmental factorsenvironmental factors play a role.play a role. it appears to result from a combination ofit appears to result from a combination of genetic and environmental risk factors, such asgenetic and environmental risk factors, such as a family history of neural tube defects, folic acida family history of neural tube defects, folic acid deficiency and medical conditions such asdeficiency and medical conditions such as diabetes and obesity.diabetes and obesity.
  • 15. Risk factorsRisk factors Race.Race. Spina bifida is more common among HispanicsSpina bifida is more common among Hispanics and whites of European descent.and whites of European descent. Family history of neural tube defects.Family history of neural tube defects. Couples who'veCouples who've had one child with a neural tube defect have a slightlyhad one child with a neural tube defect have a slightly higher chance of having another baby with the samehigher chance of having another baby with the same defect. That risk increases if two previous children havedefect. That risk increases if two previous children have been affected by the condition. In addition, a woman whobeen affected by the condition. In addition, a woman who was born with a neural tube defect, or who has a closewas born with a neural tube defect, or who has a close relative with one, has a greater chance of giving birth torelative with one, has a greater chance of giving birth to a child with spina bifida. However, most babies witha child with spina bifida. However, most babies with spina bifida are born to parents with no known familyspina bifida are born to parents with no known family history of the condition.history of the condition.
  • 16. Folic acid deficiency.Folic acid deficiency. This vitamin is importantThis vitamin is important to the healthy development of a fetus. Lack ofto the healthy development of a fetus. Lack of folic acid (vitamin B-9) increases the risk offolic acid (vitamin B-9) increases the risk of spina bifida and other neural tube defects.spina bifida and other neural tube defects. Some medications.Some medications. Anti-seizure medications,Anti-seizure medications, such as valproic acid (Depakene), seem tosuch as valproic acid (Depakene), seem to cause neural tube defects when taken duringcause neural tube defects when taken during pregnancy, perhaps because they interfere withpregnancy, perhaps because they interfere with the body's ability to use folic acid.the body's ability to use folic acid.
  • 17. Diabetes.Diabetes. The risk of spina bifida increases withThe risk of spina bifida increases with diabetes, especially when the mother's blooddiabetes, especially when the mother's blood sugar is elevated early in her pregnancy. Muchsugar is elevated early in her pregnancy. Much of this risk is preventable by careful blood sugarof this risk is preventable by careful blood sugar control and management.control and management. Obesity.Obesity. There's a link between pre-pregnancyThere's a link between pre-pregnancy obesity and neural tube birth defects, includingobesity and neural tube birth defects, including spina bifida. Obese women may have morespina bifida. Obese women may have more babies with spina bifida possibly because ofbabies with spina bifida possibly because of nutritional deficits from poor eating habits ornutritional deficits from poor eating habits or because they may have diabetes.because they may have diabetes.
  • 18. Increased body temperature.Increased body temperature. SomeSome evidence suggests that increased bodyevidence suggests that increased body temperature (hyperthermia) in the earlytemperature (hyperthermia) in the early months of pregnancy may increase themonths of pregnancy may increase the risk of spina bifida.risk of spina bifida.
  • 19. Factors that affect the severity of complicationsFactors that affect the severity of complications include:include: The size and location of the neural tube defect .The size and location of the neural tube defect . Whether skin covers the affected areaWhether skin covers the affected area Whether spinal nerves come out of the affectedWhether spinal nerves come out of the affected area of the spinal cord.area of the spinal cord. Children with myelomeningocele mayChildren with myelomeningocele may experience physical and neurological problems,experience physical and neurological problems, including lack of normal bowel and bladderincluding lack of normal bowel and bladder control, and partial or complete paralysis of theircontrol, and partial or complete paralysis of their legs.legs.
  • 20. Babies born with myelomeningocele alsoBabies born with myelomeningocele also commonly experience accumulation of fluid incommonly experience accumulation of fluid in the brain, a condition known as hydrocephalus.the brain, a condition known as hydrocephalus. Most babies with myelomeningocele will need aMost babies with myelomeningocele will need a shunt .shunt . The majority of newborns withThe majority of newborns with myelomeningocele survive.myelomeningocele survive. some may develop meningitis, an infection in thesome may develop meningitis, an infection in the tissues surrounding the braintissues surrounding the brain
  • 21. Children with myelomeningocele mayChildren with myelomeningocele may develop learning disabilities.develop learning disabilities. Children with spina bifida may also sufferChildren with spina bifida may also suffer from latex allergies, skin problems, urinaryfrom latex allergies, skin problems, urinary tract infections, gastrointestinal disorders,tract infections, gastrointestinal disorders, seizure disorders, depression, and socialseizure disorders, depression, and social and emotional problems.and emotional problems.
  • 22. Screening and diagnosisScreening and diagnosis (1)Blood tests(1)Blood tests second trimester maternal serum alphasecond trimester maternal serum alpha fetoprotein (MSAFP)fetoprotein (MSAFP) alpha-fetoproteinalpha-fetoprotein (AFP) is made naturally by the(AFP) is made naturally by the fetus and placenta.fetus and placenta. But if abnormally high levels of this proteinBut if abnormally high levels of this protein appear in the mother’s bloodstream it mayappear in the mother’s bloodstream it may indicate that the fetus has a neural tube defect.indicate that the fetus has a neural tube defect. The MSAFP test, however, is not specific forThe MSAFP test, however, is not specific for spina bifida.spina bifida.
  • 23. UltrasoundUltrasound: An advanced ultrasound can also detect: An advanced ultrasound can also detect signs of spina bifida.signs of spina bifida. AmniocentesisAmniocentesis An analysis indicates the level of AFP present in theAn analysis indicates the level of AFP present in the amniotic fluid.amniotic fluid. A small amount of AFP is normally found in amnioticA small amount of AFP is normally found in amniotic fluid.fluid. when an open neural tube defect is present, the amnioticwhen an open neural tube defect is present, the amniotic fluid contains an elevated amount of AFP because thefluid contains an elevated amount of AFP because the skin surrounding the baby's spine is gone and AFP leaksskin surrounding the baby's spine is gone and AFP leaks into the amniotic sac.into the amniotic sac. MRIMRI
  • 24. How can spina bifida be managed? - Detection - Antibiotics - Surgery - Careful observation - Physical therapy
  • 25. How can spina bifida be managed? -Detection -Triple screening -Maternal blood test for α-fetoprotein -Ultrasound for bone defects -Amniocentesis - α-fetoprotein is elevated in 75-80% of cases of spina bifida (myelomeningocele)
  • 26. Amniocentesis – using a needle to collect amniotic fluid How can spina bifida be managed?
  • 27. How can spina bifida be managed? -Antibiotics - In some cases the spinal cord is exposed to the environment - Antibiotics are essential in preventing infection of the CNS
  • 28. How can spina bifida be managed? -Surgery - In some cases the spinal cord is exposed to the environment or tethered - Surgery is performed in order to cover the spinal cord with muscle and skin or to untether the spinal cord - in utero surgery has also become a
  • 29. Early surgery on the spinal cord may allow theEarly surgery on the spinal cord may allow the child to regain a normal level of functioning andchild to regain a normal level of functioning and prevent further neurological deterioration.prevent further neurological deterioration. Some children will need subsequent surgeries toSome children will need subsequent surgeries to manage problems with themanage problems with the feet, hips, or spinefeet, hips, or spine.. Individuals withIndividuals with hydrocephalushydrocephalus generally willgenerally will require additional surgeries to replace therequire additional surgeries to replace the shuntshunt Some individuals with spina bifida requireSome individuals with spina bifida require assistive devices such asassistive devices such as braces, crutches, orbraces, crutches, or wheelchairswheelchairs. The. The location of thelocation of the malformationmalformation on the spine often indicates theon the spine often indicates the type of assistive devices needed.type of assistive devices needed.
  • 30. How can spina bifida be managed? - Careful Observation - Children with myelomeningocele often have hydrocephalus (blockage of CSF) - Children may present with paralysis, blindness, MR, inability to speak, convulsions -Any changes in mental status or behavior should be quickly brought to the attention of the child’s physician(s)
  • 31. How can spina bifida be managed? - Physical Therapy - Spinal cord damage can cause muscle weakening and wasting - Speech therapy may also be useful for some individuals
  • 32. PreventionPrevention Folic acid is an important vitamin in theFolic acid is an important vitamin in the development of a healthy fetus.development of a healthy fetus. Recent studies have shown that by adding folicRecent studies have shown that by adding folic acid to their diets, women of childbearing ageacid to their diets, women of childbearing age significantly reduce the risk of having a child withsignificantly reduce the risk of having a child with a neural tube defect, such as spina bifida.a neural tube defect, such as spina bifida. Dosage:400 micrograms of folic acid dailyDosage:400 micrograms of folic acid daily Foods high in folic acid include dark greenFoods high in folic acid include dark green vegetables, egg yolks, and some fruits.vegetables, egg yolks, and some fruits.
  • 33. prognosisprognosis Prognosis depends on the number andPrognosis depends on the number and severity of abnormalities and associatedseverity of abnormalities and associated complications.complications.