Neural Tube Defects in Resource‐Limited Settings: A Lebanese Case Series Highlighting Prevention Gaps and Challenges in Prenatal Diagnosis
Georges Yared, Charlotte El Hajjar, Nidal Hammoud, Christopher Massaad, Kariman GhazalBackground
Neural tube defects (NTDs) are congenital developmental anomalies resulting from incomplete neural tube closure during early embryonic development. They present a wide range of clinical manifestations along the craniospinal axis.
Objective
With only 6.2% of Lebanese women of childbearing age taking folic acid tablets during the adequate period, it is primordial to shed light on cases of NTDs in Lebanon. This case series presents four cases of NTDs that deviate from the conventional “zipper closure” model of neural tube development, aligning more with the modern multisite closure approach. This case series showcases the consequences of inadequate intake of folic acid prior to conception in addition to delayed prenatal diagnosis. The four cases are presented in accordance with CARE reporting guidelines.
Methods
The study presents four case reports of NTDs, including iniencephaly, anencephaly, encephalocele, and spina bifida. Each case details the clinical presentation, diagnostic findings, and outcomes.
Results
The cases demonstrate various manifestations of NTDs: (1) a case of iniencephaly with hydrocephalus and spina bifida in a 32‐week fetus, (2) a case of anencephaly in a 34‐week fetus, (3) a case of encephalocele in one fetus of diamniotic dichorionic twins at 37 weeks, and (4) a case of closed spina bifida diagnosed at 36 weeks.
Discussion
The article explores the embryology, classification, and epidemiology of NTDs. It discusses factors that can contribute to NTDs. We also note the limited prenatal follow‐up and care in vulnerable populations in Lebanon. Genetic and environmental factors are also discussed, with a particular focus on the role of folic acid and its metabolism.
Conclusion
This case series highlights the diverse presentations of NTDs. It further showcases the importance of early diagnosis and management. It also emphasizes the need for folic acid supplementation and the consideration of multiple etiologies in the prevention and understanding of NTDs.