neural tube defects training module revised june 2006 n.
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Neural Tube Defects Training Module Revised June 2006. Infant Mortality. US infant mortality rates have decreased during the 20th century, but the proportion of infant deaths attributed to birth defects has steadily increased.

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infant mortality
Infant Mortality
  • US infant mortality rates have decreased during the 20th century, but the proportion of infant deaths attributed to birth defects has steadily increased.
  • Birth defects account for approximately 20% of all infant deaths and continue to be the leading cause of infant mortality.

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risk for birth defects
Risk for Birth Defects
  • All couples in the general population have a 3-4% risk of having a child with a birth defect or genetic condition

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neural tube defects ntd s
Neural Tube Defects (NTD’s)
  • Three types:
    • Spina bifida (65%)
    • Anencephaly (25%)
    • Encephaloceles (10%)
  • NTDs occur in 1/1000 newborns in the general population of the U.S.
  • Higher incidence in East and South vs. West

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spina bifida
Spina Bifida
  • Neural tube fails to close properly
    • occurs by 28 gestational days
  • Associated problems:
    • Hydrocephalus
    • Clubfoot
    • Vertebral anomalies
    • Renal anomalies
  • Surgery for repair within 24 hours

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long term sequelae
Long Term Sequelae
  • Paralysis
  • Loss of bowel and bladder control
  • Learning disabilities

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anencephaly
Anencephaly
  • Upper end of neural tube fails to close
  • Cranial nerve tissue may be exposed
  • 10-14% have additional anomalies
  • 50% stillbirth rate
  • Usually fatal, 5% survive one week

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encephalocele
Encephalocele
  • Protrusion of brain or skin-covered brain
  • 50% have additional congenital anomaly
  • Overall mortality rate about 29%

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cost of ntds
Cost of NTDs
  • Average lifetime cost $532,000 per child
  • The cost for many exceeds $1 million
  • These figures do not include the physical, emotional costs, and costs to the family

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who is at risk to have a child with an ntd
Who Is At Risk To Have A Child With an NTD?
  • A previous pregnancy affected with NTD
  • Maternal insulin-dependent diabetes
  • Use of anti-seizure medication (i.e.valproic acid)
  • Maternal obesity
  • Exposure to high temperatures in pregnancy
  • Race/Ethnicity
  • Lower socio-economic status

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who is at risk to have a child with an ntd cont
Who Is At Risk To Have A Child With an NTD? (Cont.)
  • Women who have had a pregnancy affected with a NTD have a 4% chance of having another affected pregnancy
  • Hispanic whites have increased rates of NTDs compared to non-Hispanic whites.
  • Caucasian individuals have 2-3 x the rate of African Americans

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what causes ntds
What Causes NTDs?
  • Isolated, Multifactorial Condition
    • Combination of genetic factors and environmental factors
  • Syndromic
    • NTD as a common feature of an identified syndrome.

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folic acid supplementation
Folic Acid Supplementation
  • All women of childbearing age need 0.4 mg (400 mcg) of folic acid per day
  • Women who’ve had a previous child with a NTD and areplanning another pregnancy need adaily supplementation of 4 mg (4,000 mcg) of folic acid starting three months prior to conception and continuing through the first three months of the pregnancy.

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why take folic acid
Why Take Folic Acid
  • If a woman takes the proper amount of folic acid before she comes pregnant and during the first three months of her pregnancy…

She helps to prevent the risk of her baby developing a neural tube defect by up to 70%

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folic acid for
Folic Acid For…
  • Any woman capable of becoming pregnant
  • EVERY DAY
  • Before getting pregnant
  • LifetimeHabit

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why all women
Why All Women?
  • Half of 4 million births are unplanned
  • 2/3 of all women in the US consume insufficient levels of Folic Acid
  • Protection against disease and promote long-term health
  • Growth and repair of every cell in the body

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folic acid supplementation in ky
Folic Acid Supplementation in KY
  • According to the 2004 Kentucky Behavioral Risk Factor Survey: 45.6 percent of Kentucky women ages 18-44 reported taking a multivitamin or a vitamin containing folic acid
  • From 2000-2004, NTDs in Kentucky have decreased by 34%

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