Source: http://leovandoesburg.blogspot.com/2011/10/victory-for-human-dignity-protection-of.html
What comes to our minds when we are asked the above question?
The answer, or should I say answers, will be depending upon our different personal and educational background, age, and current status that we are in. For example, my spinal reflex answer would be “Life begins at forty” because of my current age and my personal background. For most of us, this is the time to achieve our greatest achievements. This is the time to start our legacy and to enjoy life because at this very age, we have the capabilities and capacities to do whatever we please. As long as we are happy with the results, and accepted by others.
Well, think again. I would have never re-visit the question if I am not what I am today, a person who studies the human body, specifically neurosurgery. What we are today is the result of the development of the person, us, within the accepted environment for growing up. In case we forgot, there were ‘wars’ to be won before we became what we are today. For instance, only one fifth of fetuses will survive to become a person. In addition, not all fetuses that survive will become a complete human being.
The fetus undergoes various obstacles at different stages of its formation. Firstly, when an embryo becomes a fetus. During our school years, we learned that the embryo of animals will grow accordingly to the specific species, depending on their neurotransmitters (chemical carrying communication between nerves) and peptide hormones (amino acids compound in the body). Remember the chick embryo? They looked the same as human embryo but because of the programme arranged in rigorous effort by the small molecules, they came to the ‘finished’ product accordingly. To make things complicated, for example, if neurotransmitters or peptide hormones did not appear at specific moment during the development of a fetus, the fetus remains with the uncertain characteristics of a fetus. These small molecules that will determine the sex of the fetus will have to interact with the fetus at specific time during its formation. Even if the fetus is completely formed, there are obstacles to overcome before they are born into the world.
As we discuss more on how we become human, the fear that things may go wrong at different levels will haunt us more. So much so that certain people do not even want to have children because of this fear. Studies have shown that there are certain areas of the stages of fetus formation that we can control. Therefore, we need to identify and learn which areas are within our control. I am sure that most of us would like to have our own children. So the question is, when do we decide to have one?
Life actually begins at the very early stages of conception. How do we know that we are successfully expecting a baby? Of course we can test ourselves either via a pregnancy test kit bought over the counter, or we can calculate our estimated period of amenorrhoea (last menstrual date) or we can see an obstetrician. However, by the time we know about the conception, we are actually already late by at least two weeks after the actual moment of conception. During that time, the process of life has already began. So in short, we don’t. We are not only talking about the lives of our children; it also will affect us as parents. Both parents and the child will be involved in the upbringing process. So, we should prepare ourselves from the beginning.
Source: http://article.wn.com/view/2009/03/19/Vitamin_B12_deficiency_linked_to_birth_defects/
Preconception Care
The preparation of getting a child should not only be the responsibility of women. Both men and women must be prepared in getting themselves ready to have children. The general rule to preconception care is to lead a healthy life. I will leave this topic for my colleagues to discuss later. From my perspective, as a neurosurgeon, the only worldwide recommended supplement that can make a difference is folic acid. Folic acid is a vitamin B group that is needed for the healthy growth and development of the baby in the first week of formation. Research has found that taking folic acid supplement during pregnancy reduces birth defects such as spina bifida. The recommended dose is to take at least 500 micrograms of folic acid per day for at least one month prior to pregnancy and for the first three months of pregnancy (Australia New Zealand Food Authority, 1998) whereas in U.S. Public Health Service, the recommendation is 400 micrograms. The risk of birth defects of the brain and spinal cord is reduced by 50%, especially anencephaly and spina bifida with proper folic acid supplementation. The researchers even found out that folic acid supplements can help in reducing up to 70% of recurrence in neural tube defects in subsequent pregnancies.
What exactly is a neural tube defect? What can happen to a person with neural tube defect? It is a condition that can cause a person to have varying degree of neurological deficits: from paralysis, incontinence and intellectual impairment to life incompatibility. Neural tube defects can be prevented. Despite the expertise as a neurosurgeon and facilities, which allow us to operate and correct the neural tube defect, the outcome would never be the same as a normal baby. I have seen these children and operated on them. As they grow, they have to learn in modifications of activities because they will grow up with varying degree of neurological deficits, or incomplete development that they have inherited since the beginning. Therefore, when you were born with these preventable abnormalities or without the complete package, how are you going to enjoy your life to the fullest and say, “Hey, life begins at forty.”?
Source: http://www.sbac.org/SBAC.Org__SB_Facts.htm
Folic acid supplementation in Malaysia?
Neural tube defect is a condition not much seen in high-income countries, compared to low-income countries. By scaling up supplementary of folic acid into folic acid food fortification and achieving 100% population coverage, we might reduce the occurrence of neural tube defect by more than half. Folic acid fortification is a process where folic acid is added to flour with the intention of addressing a public health problem through increasing blood folate levels in the public. US started first in 1996, followed by Canada in 1998 and they have seen better outcomes. Australia and New Zealand have agreed to implement the program but only Australia started the program in 2009. In 2008 the National Committee drafted a proposal paper for mandatory food fortification. This program was introduced to our country by a series of publications from Ho et al. in Medical Journal of Malaysia 2004, Ecology of Food and Nutrition 2006, later by Khor et al. in Asian Pasific Journal of Clinical Nutrition 2006. Based on their papers, we can conclude that Malaysia needs to do public intervention to improve our blood folate status in the population in order to prevent neural tube defect, even though we have started with compulsory folic acid supplement in our pregnancy follow up clinics. Compliance is a big issue because the public are still not aware the risks and benefits of the supplementary pills given to them. Endom et al. found that our incidence of spina bifida is 0.43 among 1000 live births, but the most worrying part is that the majority of these occur in our young mothers (average age 28 years old).
We need to educate ourselves and others in regards to importance of preconception care so that people are more aware that they can do something in preventing neural tube defects from occurring. Otherwise, they will have to see neurosurgeons, to repair the neural tube defect complications. As a neurosurgeon, I am not afraid of repairing the defects but I am more worried of the burden that the patients and their families would carry on their shoulders for the rest of their lives. Most of the patients can live longer after the correction of the defect but they have to live with whatever the defect or abnormalities they have acquired from the condition.
To all Malaysians, life does not begin at forty. It also does not begin when the heart starts beating in the womb. Life begins when you DECIDE to have children. Your life and their life will be affected by the decision you have made. Try to take action within areas under our control in order to live to the optimal potential of a human being. Go on and live.
Dr. Rahmat is a neurosurgeon who believes strongly that knowledge empowers the public to make the right choices. Read more about him at The Team page.
[This article belongs to The Malaysian Medical Gazette. Any republication (online or offline) without written permission from The Malaysian Medical Gazette is prohibited.]
References:
- Committee on Genetics. Folic Acid for the Prevention of Neural Tube Defects. Pediatrics Aug1999;Vol 104;No 2; pp325-7
- Hannah Blencowe et al. Folic acid to reduce neonatal mortality from neural tube disorders. Intern J of Epidemiology 2010;39;pp i110-i121
- The National Technical Committee of Food Fortification Ministry of Health Malaysia. Proposal Paper on Mandatory Fortification of Wheat Flour with Iron and Folic Acid. MINISTRY OF HEALTH MALAYSIA 2008 (15 August 2008)
- Endom Ismail et al. Incidence of Spina Bifida: An Eight-Year Analysis At Kuala Lumpur Hospital. Poster Papers:Medical & Human Genetics. Proceedings of the 8th Malaysia Congress on Genetics Aug 2009
- Committee on Genetics. Folic Acid for the Prevention of Neural Tube Defects. Pediatrics Aug1999;Vol 104;No 2; pp325-7
- Hannah Blencowe et al. Folic acid to reduce neonatal mortality from neural tube disorders. Intern J of Epidemiology 2010;39;pp i110-i121
- The National Technical Committee of Food Fortification Ministry of Health Malaysia. Proposal Paper on Mandatory Fortification of Wheat Flour with Iron and Folic Acid. MINISTRY OF HEALTH MALAYSIA 2008 (15 August 2008)
- Endom Ismail et al. Incidence of Spina Bifida: An Eight-Year Analysis At Kuala Lumpur Hospital. Poster Papers:Medical & Human Genetics. Proceedings of the 8th Malaysia Congress on Genetics Aug 2009