24. Normal Folate Adequate Folate – Healthy Cells Deficient Folate – Unhealthy Cells Perspective on Folate Deficiency Megaloblastic Anemia
25. 50% of U.S. pregnancies are unplanned Folic acid is needed before conception NTDs occur very early in pregnancy Importance of timing in getting folic acid
26. Median serum and red blood cell folate levels, before and after folic acid fortification, U.S. women, aged 15-44 years, NHANES SOURCE: CDC/NCHS, National Health and Nutrition Examination Surveys, 1988-94 and 1999-2000 4.8 0 5 10 15 20 ng/mL Serum folate 13.0 Before After ng/mL 159.9 263.6 0 50 100 150 200 250 300 350 Red blood cell folate Before After
38. Lypomyelomeningocele The left child is a dorsal lipoma – pedunculated. The right child lypomatous mass beneath the skin. Both passed through the dura to the intradural space.
39. Spinal cord (close up) location of spina bifida Occulta Outer part of vertebrae not completely joined. Spinal cord and covering (meninges) usually undamaged. Hair often at site of defect. Meningocele Outer part of vertebrae split. Spinal cord usually normal. Meninges damaged and displaced through opening. Myelomeningocele Outer part of vertebrae split. Spinal cord and meninges damaged and displaced through opening. Usually hydrocephalus.
40. Anomalies Associated with Myelomeningocele Approximate Percent of Patients Chiari II malformation 90%+ Hydrocephalus 90%+ Syringomyelia 88% Brainstem malformations (cranial nerve) 75% Cerebral ventricle abnormalities 90%+ Cerebellar heterotopias 40% Cerebral heterotopias 40% Agenesis of the corpus callosum 12% Polymicrogyria 15-30%
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43. Spina Bifida Occulta The child has long hairy tail with underline spina bifida occulta.
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