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Reducing the prevalence of birth defects in Georgia

© UNICEF Georgia/2013
In Georgia, a national nutrition survey showed that 36 per cent of reproductive-age women in Georgia suffer from folic acid deficiency. Taking a daily pill is an easy way to protect the foetus.

By Jody McPhillips

TBILISI, Georgia, 28 June 2013 – Maka Vashakidze has two daughters. The toddler smiles shyly as she greets the group of visitors.

The baby, Mariam, is 4 months old. She lies in a hot room in the Tbilisi suburb of Didi Dighomi, her tiny feet motionless in red footie pajamas.

Mariam can neither hear nor see. She sometimes makes a small sound in her throat, like a cough. The family is alert to every nuance.

“She cannot eat,” says Ms. Vashakidze. “We feed her through a tube. Sometimes she has mucus in her throat, which could choke her, so we can’t leave her for a second.”

Consequences of malnutrition

The first half of Mariam’s life was spent in the Iashvili Children’s Central Hospital in Tbilisi.

Mariam was born with spina bifida, a neural tube defect that occurs during early pregnancy when the spinal column does not close properly. The resulting damage can include severe physical and mental disability, or death. 

Studies show that up to 70 per cent of neural tube defects are preventable if women capable of becoming pregnant consume at least 400 micrograms of folic acid daily.

In Georgia, an estimated 126 children per year will suffer from spina bifida. A 2012 study by UNICEF Georgia says that treatment for children who survive this and other neural tube defects will cost US$4.1 million annually.

Malnourished children will be less successful both at school and when they enter the workforce, the study says.  It also reports that nearly 300 children under 5 die every year in Georgia as a result of maternal anaemia, low birth weight, folic acid-related birth defects and problems with breastfeeding. Over 10 years, this national burden of malnutrition is estimated at US$1.3 billion, including about 3,400 premature deaths of children.

“Very little hope”

According to data from the Iashvili hospital, about 70 children with neural tube defects undergo treatment each year in Georgia. The hospital estimates another 57 foetuses diagnosed with the condition via ultrasound are aborted.

Dr. Genrieta Gagoshidze, who performs approximately 600 ultrasounds per month at the hospital’s Embryotox Clinic, says that about five per month reveal neural tube defects. And, while the severity of the impairment varies, “In general, there is very little hope for these children.”

“They will be born with very serious problems and will need constant treatment,” says Dr. Gagoshidze.

Some women deliver, but then abandon the infant to state care. Since 2008, 36 such children have been sent to the Tbilisi Infant Home. Of those children, more than half have died – almost 70 per cent within the first six months. One has been reunited with family.

© UNICEF/NYHQ2004-0966/Pirozzi
Maka Vashakidze holds 4-month-old Mariam, in Tbilisi. Mariam was born with spina bifida. Ms. Vashakidze was not aware that women of childbearing age should take folic acid to prevent birth defects such as spina bifida.

Folic acid – a simple way to protect the foetus

Like many other Georgian women, Ms. Vashakidze had no idea that she should have been taking folic acid during her childbearing years.

The National Nutrition Survey 2009 shows that 36 per cent of reproductive-age women in Georgia suffer from folic acid deficiency. The natural form of the micronutrient, called folate, is found in leafy green vegetables, fruits, beans, yeast and liver. Folic acid, the synthetic form used in dietary supplements, is about twice as bioavailable, or easily used by the body, as the naturally occurring folate in foods.
Taking a daily pill is an easy way to protect the foetus. The problem is that spina bifida occurs during the first 12 weeks of pregnancy, when many women don’t yet realize they are pregnant. Doctors say women who intend to get pregnant need to take folic acid before conceiving, to protect their babies.

But, in Georgia, about a third of pregnancies are unplanned. Many women don’t go to see a doctor until they are two or three months along – and, by then, it is too late.


Spina bifida is often accompanied by disruptions in the flow of fluid that bathes the brain and spinal cord. The fluid can build up in an infant’s brain, causing an enlarged cranium, which often results in severe mental and physical disability, even if treated.

Mariam’s first surgery was to correct the deformation in her spinal column; the second was to install a shunt to drain the accumulating fluid from her brain. A third was necessary to clear a blockage in the shunt. Ms. Vashakidze says there may be more blockages, and more surgeries, in the future.

Mariam’s shunt relieved the intracranial pressure. It is too soon to know if her intellect has been impaired.

For now, they watch and wait.

“I don’t lose hope,” says Ms. Vashakidze. “The whole family is really looking for everything. When Mariam first came home, after the shunt was put in, both of her eyes were closed. And then, one eye opened halfway. By the third day, both eyes were open,” she says. “Every little thing really means a lot.”

Reducing the prevalence of birth defects

UNICEF says it won’t cost much to reduce the prevalence of this kind of birth defect, as well as other nutrition-related problems. Some proposed steps include public education about proper nutrition, promotion of breastfeeding, support and counseling of pregnant women and new mothers, nationwide flour fortification, maternal and child micronutrient supplementation and folic acid supplementation.  

If these steps are taken, UNICEF estimates that the costs associated with malnutrition in Georgia over 10 years could be reduced by 25 per cent. Most important, nearly 1,000 children’s lives could be saved.



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