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Dr. Andrew Rynne

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Had abortion due to anencephaly. Prescribed folic acid tablet. Will this affect future pregnancy?

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Dr. Aarti Abraham

OBGYN

Practicing since :1998

Answered : 5981 Questions

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Posted on Mon, 21 Jan 2013 in Pregnancy
Question: Hi,

I'm a 29 years old male.I got married in feb 2012.My wife got pregant in Jun 2012 and during the fixth month of pregancy in the anomaly sacn it had been identified that for the foetus the valut of the skull hasn't been developed.

The doctor we have consulted and the one in scan centre(Mediscan,chennai) have informed us that 99% this could be folic acid deficiency and 1% could be genetic reasons.They have suggested to abort the child and we did so and gave the foetus for autopsy to know the exact reason for this neural defect to prevent for future pregancy

It would around 40-days that we don't know that my wife has been preganant.When the next period hasn't happened then only we have noticed and consulted a doctor.The doctor had given folic acid tablets since then.

I want to know whether this wil affect the future pregnancy?

doctor
Answered by Dr. Aarti Abraham 32 minutes later
Hello XXXXXXX,
Thanks for your query on this portal.

Anencephaly is the technical term for the condition in your previous baby, where the skull vault was not developed.
The cause of anencephaly is disputed. A woman who has had one child with a neural tube defect such as anencephaly has about a 3% risk of having another child with a similar problem, as opposed to normal risk of 0.1 % for general population. This points to hereditary factor.
Women with diabetes and on anti convulsion medications have higher risk of recurrence. The addition of folic acid to the diet of women of child-bearing age may significantly reduce, although not eliminate, the incidence of neural tube defects. Therefore, it is recommended that women with a previous affected baby consume 4 mg of folic acid daily, specially prior to conceiving, as it reduces the risk to 0.03 %. It is not advisable to wait until pregnancy has begun, since by the time a woman knows she is pregnant, the critical time for the formation of a neural tube defect has usually already passed.
You could also send me the fetal autopsy report of the previous baby, to know whether any associated abnormalities were present. You can use the option on the right hand side of the page to attach the scanned copy, if you have it.
An extremely rare, but similar condition in presentation , is Acrania, but there, the recurrence risk is low.
The exact diagnosis would be present on the autopsy report, hence am requesting it.
Regarding this present pregnancy, it would have been advisable to plan it after taking folic acid for atleast 6 weeks or more. However, since your wife has already conceived, now the following steps can be taken :
1. Continue taking 4 mg/day of folic acid and other antenatal supplements as prescribed by your obstetrician sincerely everyday.
2. Go in for early detection via ultrasound in the first trimester, as anencephaly can be diagnosed reliably after 12 weeks.
3. Estimation of maternal alphafeto protein is an early marker of anencephaly and related defects.
4. Consultation with an expert Genetic Counsellor, to know the exact risks of recurrence, and appropriate tests to be undergone at specific weeks of pregancy to diagnose the condition.

All said and done, the recurrence risk is 4 %, but that still gives you a fairly wide margin of having a normal child this time, particularly if the previous fetal autopsy report was normal.

Take care, and feel free to ask for clarifications.
Above answer was peer-reviewed by : Dr. Mohammed Kappan
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