Question of the Month: I am a woman with Spina Bifida and I wish to have a child. What is my likelihood of being able to get pregnant? Is there anything I can do to help? What complications could happen if I got pregnant?

Congratulations on your decision to become a parent! I am happy to report that many women living with Spina Bifida are able to become pregnant, maintain a safe pregnancy, and deliver a healthy baby.

Folic acid every day
If you have had regular menstrual periods then you are most likely able to become pregnant. Not all women are aware of this fact and some assume that because of their Spina Bifida and/or hydrocephalus, they are not capable of becoming pregnant. There is no evidence that women with Spina Bifida have lesser fertility than women without Spina Bifida.

For this reason, it is very important that all sexually active women who are of child-bearing age take a multivitamin with folic acid every day. The recommended dose of 400mcg (0.4mg) is in most daily multivitamins. If you are planning to become pregnant and you have Spina Bifida, the Spina Bifida Association recommends you take 10 times the regular recommended folic acid dose. This equals 4mg of folic acid daily.

You can get folic acid over the counter at most pharmacies and health food stores. If you take 4mg daily you should not get this dose from taking extra multivitamins or extra prenatal vitamins. You would get too much of the other vitamins. Therefore, you should buy folic acid-only vitamins and take as many pills as needed to get 4mg. Start taking the 4mg dose at least 3 months before attempting to become pregnant and at least 3-4 months into the pregnancy.

Ability to become pregnant and maintain pregnancy
Although the ability to become pregnant is not significantly changed by having Spina Bifida, the ability to maintain the pregnancy to term can be impacted by the level of lesion, amount of previous abdominal and pelvic surgery, and structure of the genital tracts.

Because some women with Spina Bifida have structural changes in their uterus (womb), it is helpful to have an examination by a obstetrician/gynecologist (possibly with ultrasound) to make sure the uterus can support a pregnancy. During this evaluation the:

• bladder,
• kidneys,
• ureters,
• pelvic size,
• lower body flexibility, and
• shunt tubing

can also be evaluated. Because pregnancy in Spina Bifida is not routine, seeking care form an obstetrician with expertise in high-risk pregnancies is advisable. Notify this obstetrician's staff about any latex allergies and negotiate a latex-free delivery environment.

Before pregnancy
Before pregnancy begins, it is important to review chronic medications, particularly those for bladder management, hypertension, and seizures. There are medications considered safer in pregnancy which can be used. It is also important of the high risk obstetrician to know about previous surgeries, especially abdominal and pelvic procedures and complications.

During pregnancy
During pregnancy, women with Spina Bifida can have unique medical concerns. Many women with Spina Bifida develop frequent urinary tract infections, and may be encouraged to monitor their urine at home using urine dipsticks to look for infection cells and bacteria.

As the baby develops, it can press down on the bladder, out on the spine and spinal cord, up on the lungs, and out on the ureters, urinary diversion tracts, and bowel and cecostomy tracts. There have been reports of:

• worsening scoliosis (curvature of the spine),
• decreased bladder function,
• urine trapping and reflux into the kidneys,
• difficulty catherizing Mitrofanoffs and other continent diversion tracts, and
• prolapse (outpouching) of tracts though stomas.

Pressure on the peritoneal shunt tubing can affect drainage of hydrocephalus. The increased weight of the baby can cause pressure sores, balance and mobility issues. All of these issues can be managed with the assistance of your high-risk obstetrician and adult Spina Bifida specialists.

Despite these many considerations, many women with Spina Bifida have healthy pregnancies and safe deliveries resulting in beautiful children. More information is available in the Spina Bifida Association's Health Guide for Adults Living with Spina Bifida.

For more information on the genetics and factors associated with Spina Bifida, please visit the Spina Bifida Association fact sheet.

Interested in submitting a question for Question of the Month? Email us at sbaa@sbaa.org.

The information provided here is for informational, educational and entertainment purposes only. It is not intended to replace, and should not be interpreted or relied upon as, medical or professional advice. Your use of this site means that you agree to the terms and conditions detailed in our disclaimer.

For past questions and answers visit the Ask the Doctor archive.