October is both Spina Bifida Awareness Month and Hispanic Heritage Month, so let’s talk about how spina bifida disproportionately affects the Hispanic/Latino population, including the Latin American immigrant population, in the United States.
What is Spina Bifida?
Spina bifida is a birth defect that affects the spine. Some people have such a mild condition that they don’t realize they are affected by spina bifida, whereas others have more complicated physical disabilities.
Spina bifida has been recorded since the age of Hippocrates, but was not given a name until the mid-1600s. More research needs to be done to understand what causes it, but studies have shown that people who get low levels of folic acid from their diet are at a higher risk of having babies with the birth defect, so doctors encourage pregnant people to increase folic acid intake, as well as that of B12 and zinc.
Anatomically, spina bifida is a disorder where the spinal column doesn’t fully close during prenatal development. There are different types of this neural tube disorder. The first is what most people think of when they hear spina bifida, and that is Myelomeningocele, where a sac of fluid is attached to the baby’s back and within that sack are damaged nerve endings and part of the spinal cord. This can lead to moderate to severe physical disabilities. Another type of spina bifida is meningocele, where a sac of fluid comes through an opening in the baby’s back but the spinal cord and nerve endings are not present in this sac, so physical disabilities are minimal. Lastly, there’s spina bifida occulta, or “hidden” spina bifida, because there’s no visible sac. In addition, many people don’t know they have it until later in life.
In the United States, the birth prevalence of spina bifida is seven cases per 10,000 live births, whereas in certain regions of Latin America, it has been reported to be as high as 96 cases per 10,000. And, Hispanics/Latino immigratants consistently have a higher birth prevalence of spina bifida compared with other racial/ethnic groups.
Why is this the case?
One of the first things a doctor will look at in assessing if a fetus is at risk of developing spina bifida is the diet of the mother. While the FDA requires that all enriched cereal grains be fortified with folic acid, fortification is not required for corn masa flour, which is used to make corn tortillas, a staple food in many Latin American countries. A research article in JAMA analyzed corn masa flour and corn tortilla products in 11 grocery stores in the Atlanta area catering to Hispanic consumers. Only two of 20 corn masa flour products, and none of the 21 soft corn tortilla products, were labeled as containing folic acid, the main nutrient required to prevent spina bifida. But, obviously this isn’t 100% the reason why there is a higher prevalence of spina bifida in Hispanic and Latin American communities.
The Hispanic/Latino population in the United States has the greatest amount of uninsured people (17.7% uninsured), according to the US Census. This means that it is less likely for mothers to receive the proper prenatal care that they need, including regular visits with an OB/GYN to help monitor their folic acid levels and access to prenatal vitamins. Although prenatal vitamins can be found over-the-counter, a bottle can typically run around 40-70 USD, which isn’t a feasible cost for many uninsured people; additionally, due to lack of healthcare visits, they may not understand the importance of taking such vitamins to ensure proper folic acid levels for them and their baby.
As the population of Hispanics/Latinos in the US continues to increase, it’s important that students and healthcare professionals understand the high prevalence that diseases such as spina bifida have within this population, and understand the social determinants of health behind that in order to try and mitigate them for patients now and in the future. This also includes conducting research studies on spina bifida including Hispanic/Latino patients in order to accurately represent the population who suffers from the condition.