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Birth defects

  • Birth defects are health conditions present at birth.
  • They can cause problems in how the body works.
  • About 120,000 babies born each year have a birth defect.
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Spina bifida

Spina bifida means open spine. The spine (backbone) protects the spinal cord, a bundle of nerves that runs down the middle of your back. The spinal cord carries signals back and forth between your body and your brain. Spina bifida happens when the bones in the spine don’t form correctly, or when the spinal cord doesn’t form correctly, leaving a gap or opening. Spina bifida can happen anywhere along the spine.

Spina bifida is the most common kind of neural tube defect (also called NTD). NTDs are birth defects of the brain and spinal cord. Birth defects are health conditions that are present at birth. Birth defects change the shape or function of one or more parts of the body. They can cause problems in overall health, in how the body develops or in how the body works.

A baby’s neural tube normally develops into the brain and spinal cord. It starts out as a tiny, flat ribbon that turns into a tube by the end of the first month of pregnancy. NTDs happen if the tube doesn’t close completely. 

About 1,500 to 2,000 babies are born with spina bifida each year in the United States.

How can spina bifida affect your baby?

Spina bifida can affect how your baby’s brain, spine, spinal cord and meninges develop. Meninges are the tissues that cover and protect the brain and the spinal cord.

The four types of spina bifida are: 

  1. Spina bifida occulta (also called hidden spina bifida). This is the mildest form and usually doesn’t cause health problems. In this condition, the gap in the spine is small. The spinal cord and nerves stay in place and usually aren’t damaged. A dimple, hairy patch, dark spot or swelling may appear on the skin over the gap. If you see something like this at the bottom of your baby’s back, tell your baby’s health care provider. 
  2. Closed neural tube defect. In this condition, the fat, bone or meninges around the spinal cord don’t form correctly. This sometimes damages the nerves in the spinal cord. This condition often causes no symptoms, but some babies may have problems controlling their bladder and bowels (going to the bathroom).
  3. Meningocele. This is the rarest form. In this condition, the meninges push out through the gap in the spine. This creates a sac filled with fluid (called a meningocele) on the baby’s back. There’s usually little or no nerve damage, but some babies may have problems controlling their bladder and bowels. Surgery can remove the meningocele.
  4. Myelomeningocele (also called open spina bifida). This is the most severe and the most common form of spina bifida. In this condition, part of the spinal cord pushes out with the meninges through the gap in the spine to form a sac on the baby’s back. The spinal cord and nearby nerves are damaged. This condition can cause paralysis (when you can’t feel or move one or more parts of your body) and life-threatening infections. Babies with this condition need surgery before birth or within the first few days of life. During surgery, a surgeon tucks the spinal cord and nerves back into the spine and covers them with muscle and skin. This can help prevent new nerve damage and infection. But the surgery can’t undo any damage that’s already happened. Even with surgery, babies with this condition have lasting disabilities, like problems walking and going to the bathroom. 

What health problems can spina bifida cause and how are they treated?

Spina bifida can cause a number of health problems, including: 

Chiari II malformation. This condition happens when the lower part of the brain sits in the upper part of the neck. Some babies with this condition have hydrocephalus (fluid buildup in the brain), weakness in the upper body (like in the arms and hands) and/or breathing or swallowing problems. Babies with this condition usually have myelomeningocele.

Hydrocephalus. Extra fluid can cause the head to swell and put pressure on the brain. Hydrocephalus can cause intellectual and developmental disabilities. These are problems with how the brain works that can cause a person to have trouble or delays in physical development, learning, communicating, taking care of himself or getting along with others. In some cases, a surgeon needs to drain the extra fluid from a baby’s brain.

Latex allergy. Many babies with spina bifida are allergic to latex (natural rubber). If your baby is allergic to latex, keep him away from items made of latex like rubber nipples and pacifiers. 

Learning disabilities. Children with spina bifida sometimes have problems with language, reading, math and paying attention. 

Meningitis. This is an infection of the meninges that causes swelling in the brain and spinal cord. Meningitis can damage the brain and can be life-threatening. If your baby has meningitis, she may need antibiotics (medicine that kills infections caused by bacteria). 

Paralysis. People with spina bifida higher on the spine may have paralyzed legs or feet and need to use wheelchairs. Those with spina bifida lower on the spine (near the hips) may have more use of their legs. They may be able to walk on their own or use crutches, braces or walkers to help them walk. Some babies can start exercises for the legs and feet at an early age to help them walk with braces or crutches when they get older.

Skin problems. People with spina bifida can develop sores, calluses, blisters and burns on their feet, ankles and hips. But they may not know they have these problems because they may not be able to feel certain parts of their body. Your baby’s provider can recommend ways to help prevent skin problems.

Tethered spinal cord. This condition happens when the spinal cord is held tightly in place, causing the cord to stretch as your baby grows. The stretching can cause nerve damage in the spine. Babies with tethered spinal cord may have problems like back pain and a curved spine (also called scoliosis). Tethered spinal cord can be treated with surgery. This condition affects babies with myelomeningocele, meningocele and spina bifida occulta.

Urinary tract infections (also called UTIs). The urinary tract is the system of organs (including the kidneys and bladder) that helps your body get rid of waste and extra fluids in the urine. Babies with spina bifida often can’t control when they go to the bathroom because the nerves that help a baby’s bladder and bowels work are damaged. If your baby has problems emptying the bladder completely, this can cause UTIs and kidney problems. Your baby’s health care provider can teach you how to use a plastic tube called a catheter to empty your baby’s bladder. 

Other conditions. Some people with spina bifida have problems with: 

Does your baby need a team of providers to treat spina bifida?

Yes. Depending on your baby’s health problems, his team may include: 

  • Pediatrician. This is a doctor who has special training to take care of babies and children.\
  • Neurologist. This is a doctor who treats problems of the nervous system, including the brain, spinal cord and nerves.
  • Urologist. This is a doctor who treats problems of the urinary tract (kidneys, bladder, ureters and urethra).
  • Orthopedist. This is a doctor who treats injuries and diseases of the bones, joints, ligaments, tendons, muscles and nerves.
  • Psychologist. This is a person trained to help people with social and mental health problems. 
  • Psychiatrist. This is a doctor who treats mental illness. 
  • Developmental therapist. This is a person trained to help with behavior and social skills.
  • Occupational therapist. This is a person trained to help people do everyday activities, such as holding and letting go of things, getting dressed and feeding themselves.
  • Physical therapist. This is a person who creates exercise programs to help improve strength and movement. 

What causes spina bifida?

We’re not sure exactly what causes spina bifida, but these things may play a role:

Ethnic group. This is a group of people, often from the same country or region, who share language or culture. Spina bifida and other NTDs are more common in Caucasians and Hispanics and less common among Ashkenazi Jews, most Asian groups and African- Americans.

Folic acid. Folic acid is a B vitamin that every cell in your body needs for normal growth and development. Taking 400 micrograms of folic acid every day before and during early pregnancy may help reduce your baby’s risk for NTDs. You need folic acid when you’re pregnant, too. During pregnancy, take a prenatal vitamin each day that has 600 micrograms of folic acid in it.

If you have spina bifida or if you’ve had a baby or a pregnancy with an NTD, talk to your health care provider before getting pregnant again about how much folic acid you should take. 

Genes. Genes are the part of your body’s cells that store instructions for the way your body grows and works. Genes are passed from parents to children. Sometimes changes in genes can cause conditions like spina bifida. Parents can pass these gene changes to their children. You may be more likely than others to have a baby with spina bifida if:

  • You or your partner has spina bifida. When one parent has spina bifida, there’s a 1 in 25 (4 percent) chance of passing spina bifida to your baby.
  • You already have a child with spina bifida. In this case, there’s a 1 in 25 (4 percent) chance of having another baby with spina bifida. 

In these cases, you may want to see a genetic counselor. This is a person who is trained to help you understand how genes, birth defects and other medical conditions run in families, and how they can affect your health and your baby’s health. In most cases, spina bifida happens without any family history of the condition. This means no one in your family or your partner’s family has spina bifida.

Health conditions. Health conditions and medicines you take during pregnancy may play a role in causing spina bifida:

  • Get to a healthy weight before pregnancy.
  • Get treatment for health conditions, like diabetes.
  • Tell your provider about any medicines and supplements you take. This includes any prescription and over-the-counter medicines, supplements and herbal products. Your provider may tell you to stop taking a medicine or switch you to one that’s safer during pregnancy. For example, some anti-seizure medicines may increase your risk of having a baby with an NTD

Getting overheated during pregnancy. This may increase your chances of having a baby with spina bifida. Don’t use hot tubs or saunas when you’re pregnant. If you have a fever, take acetaminophen (Tylenol®) right away and call your provider.

How do you know if your baby has spina bifida?

Spina bifida can be diagnosed during pregnancy or after your baby is born. Spina bifida occulta may not be diagnosed until later in life.  

During pregnancy

You may have prenatal tests (medical tests you get during pregnancy) to check your baby for spina bifida and other birth defects. These tests include:

  • Maternal blood screening. This test measures substances in your blood. If you have high levels of a substance called alpha-fetoprotein (also called AFP), your baby may have spina bifida. The test is done at 15 to 20 weeks of pregnancy.
  • Amniocentesis (also called amnio). This test takes some fluid (called amniotic fluid) from around your baby in the uterus (womb). The test checks the fluid for birth defects and genetic conditions. You can get this test at 15 to 20 weeks of pregnancy
  • Ultrasound. This test uses sound waves and a computer screen to make a picture of your baby in the womb. Providers may see spina bifida with this test. 

After your baby is born

In some cases, providers diagnose a baby’s spina bifida after birth. A hairy patch of skin or a dimple on your baby’s back may be the first sign of spina bifida. If your provider thinks your baby has spina bifida, she may use one of these tests to get a clearer view of your baby’s spine: 

  • Computed tomography (also called CT or CAT scan). CT scans use special X-ray equipment and powerful computers to make pictures of the inside of your body. 
  • Magnetic resonance imaging (also called MRI). MRIs use a large magnet and radio waves to look at organs and structures in your body. 
  • X-ray. X-rays use radiation to make a picture of your baby’s body on film.

Last reviewed May 2014

See also: Neutral tube defects

Call your provider now if your baby

  • Has a temperature above 100.4º F
  • Has trouble breathing or is hard to waken
  • Has blood in her vomit or stool
  • Has yellowish skin or eyes
  • Is having a seizure

Frequently Asked Questions

Can dad's exposure to chemicals harm his future kids?

Dad's exposure to harmful chemicals and substances before conception or during his partner's pregnancy can affect his children. Harmful exposures can include drugs (prescription, over-the-counter and illegal drugs), alcohol, cigarettes, cigarette smoke, chemotherapy and radiation. They also include exposure to lead, mercury and pesticides.

Unlike mom's exposures, dad's exposures do not appear to cause birth defects. They can, however, damage a man's sperm quality, causing fertility problems and miscarriage. Some exposures may cause genetic changes in sperm that may increase the risk of childhood cancer. Cancer treatments, like chemotherapy and radiation, can seriously alter sperm, at least for a few months post treatment. Some men choose to bank their sperm to preserve its integrity before they receive treatment. If you have a question about a specific exposure, contact the Organization of Teratology Information Specialists at www.otispregnancy.org.

Can Rh factor affect my baby?

The Rh factor may be a problem if mom is Rh-negative but dad is Rh-positive. If dad is Rh-negative, there is no risk.

If your baby gets her Rh-positive factor from dad, your body may believe that your baby's red blood cells are foreign elements attacking you. Your body may make antibodies to fight them. This is called sensitization.

If you're Rh-negative, you can get shots of Rh immune globulin (RhIg) to stop your body from attacking your baby. It's best to get these shots at 28 weeks of pregnancy and again within 72 hours of giving birth if a blood test shows that your baby is Rh-positive. You won't need anymore shots after giving birth if your baby is Rh-negative. You should also get a shot after certain pregnancy exams like an amniocentesis, a chorionic villus sampling or an external cephalic version (when your provider tries to turn a breech-position baby head down before labor). You'll also want to get the shot if you have a miscarriage, an ectopic pregnancy or suffer abdominal trauma.

Does cleft lip or cleft palate cause dental problems?

A cleft lip or cleft palate that extends into the upper gums (where top teeth develop) can cause your baby to have certain dental problems, including:

  • Missing teeth
  • Too many teeth
  • Oddly shaped teeth
  • Teeth that are out of position around the cleft

Every baby with a cleft lip or palate should get regular dental checkups by a dentist with experience taking care of children with oral clefts. Dental problems caused by cleft lip or palate usually can be fixed. If needed, your baby can get ongoing care by a team of experts, including:

  • A dentist
  • An orthodontist to move teeth using braces
  • An oral surgeon to reposition parts of the upper jaw, if needed, and to fix the cleft

See also: Cleft lip and cleft palate

 

Does cleft lip or cleft palate cause ear problems?

Cleft lip does not cause ear problems.

Babies with cleft palate, however, are more likely than other babies to have ear infections and, in some cases, hearing loss. This is because cleft palate can cause fluid to build up in your baby’s middle ear. The fluid can become infected and cause fever and earache. If fluid keeps building up with or without infection, it can cause mild to moderate hearing loss.

Without treatment , hearing loss can affect your baby’s language development and may become permanent.

With the right care, this kind of hearing loss is usually temporary. Your baby’s provider may recommend:

  • Having your baby’s ears checked regularly for fluid buildup
  • Medicines for treating fluid buildup and ear infections
  • Ear tubes if your baby has fluid in his ears over and over again. Ear tubes are tiny tubes that are inserted into the eardrum to drain the fluid and help prevent infections.

See also: Cleft lip and cleft palate

Does cleft lip or cleft palate cause problems with breastfeeding?

Babies with only a cleft lip usually don’t have trouble breastfeeding. Most of the time, they can breastfeed just fine. But they may need some extra time to get started.

Babies with cleft lip and palate or with isolated cleft palate can have:

  • Trouble sucking strong enough to draw milk through a nipple
  • Problems with gagging or choking
  • Problems with milk coming through the nose while feeding

Most babies with cleft palate can’t feed from the breast. If your baby has cleft palate, he can still get the health benefits of breastfeeding if you feed him breast milk from a bottle. Your provider can show you how to express (pump) milk from your breasts and store breast milk.

Your baby’s provider can help you start good breastfeeding habits right after your baby is born. She may recommend:

  • Special nipples and bottles that can make feeding breast milk from a bottle easier
  • An obturator. This is a small plastic plate that fits into the roof of your baby’s mouth and covers the cleft opening during feeding.

See also: Cleft lip and cleft palate, Breastfeeding

Does cleft lip or cleft palate cause speech problems?

Children with cleft lip generally have normal speech. Children with cleft lip and palate or isolated cleft palate may:

  • Develop speech more slowly
  • Have a nasal sound when speaking
  • Have trouble making certain sounds

Most children can develop normal speech after having cleft palate repair. However, some children may need speech therapy to help develop normal speech.

See also: Cleft lip and cleft palate

What are choroid plexus cysts?

The choroid plexus is the area of the brain that produces the fluid that surrounds the brain and spinal cord. This is not an area of the brain that involves learning or thinking. Occasionally, one or more cysts can form in the choroid plexus. These cysts are made of blood vessels and tissue. They do not cause intellectual disabilities or learning problems. Using ultrasound, a health care provider can see these cysts in about 1 in 120 pregnancies at 15 to 20 weeks gestation. Most disappear during pregnancy or within several months after birth and are no risk to the baby. They aren't a problem by themselves. But if screening tests show other signs of risk, they may indicate a possible genetic defect. In this case, testing with higher-level ultrasound and/or amniocentesis may be recommended to confirm or rule out serious problems.

What if I didn't take folic acid before pregnancy?

If you didn’t take folic acid before getting pregnant, it doesn't necessarily mean that your baby will be born with birth defects. If women of childbearing age take 400 micrograms of folic acid every day before and during early pregnancy, it may help reduce their baby’s risk for birth defects of the brain and spin called neural tube defects (NTDs). But it only works if you take it before getting pregnant and during the first few weeks of pregnancy, often before you may even know you’re pregnant.

Because nearly half of all pregnancies in the United States are unplanned, it's important that all women of childbearing age (even if they're not trying to get pregnant) get at least 400 micrograms of folic acid every day. Take a multivitamin with folic acid before pregnancy. During pregnancy, switch to a prenatal vitamin, which should have 600 micrograms of folic acid.

Last reviewed November 2012

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