Scenario: A 6-year-old female child with a diagnosis of spina bifida at L2-L3 is referred to physical therapy for evaluation and treatment. The mother reports not being aware of her pregnancy until 9 weeks gestation. At 14 weeks, a fetal ultrasound indicated the presence of myelomeningocele. As a result, the infant was delivered via C-section to prevent rupture of the lumbosacral sac. The infant had surgery to close the sac within 24 hours after birth and placement of a ventroperitoneal shunt within 72 hours after birth. The child received physical therapy as an infant and young child and currently receives services through the public school system. The family requested outpatient physical therapy now to teach the patient how to transfer herself independently as she has grown too large for the mother to transfer her by herself.

Question: During those first 9 weeks where the mother was unaware of pregnancy, what vitamin may have been missing in her diet that could have affected development of spina bifida in the child?

Potential answers:

1. B Vitamins
2. Iron
3. Vitamin D
4. Folic Acid

Answer with rationale: 4. Folic Acid

Spina bifida is an incomplete closure of the neural tube during development, leading to structural deformities in the spinal cord and surrounding structures. Folic acid plays an important role in preventing neural tube defects, including spina bifida.

B vitamins are significant for development by creating adequate levels of plasma pyridoxal phosphate for the fetus, and increased levels of the vitamins required for the mother during the pregnancy.

Iron is an vital nutrient for reducing the chances of low birth rate, along with folic acid and vitamin D.

^{For more information see Chapter 253 Spina Bifida in The Color Atlas Of Physical Therapy}