Before the First Breath: Celebrating AIIMS’ Breakthrough—and the Power of Prevention

Before the First Breath: Celebrating AIIMS’ Breakthrough—and the Power of Prevention

By Dr. Shafeeq Ahmed

India has good reason to applaud the team at AIIMS, New Delhi. On 12 November 2026, doctors performed what the institute reported as India’s first open fetal surgery for a severe spinal defect. The six-hour operation, undertaken at 25 weeks of pregnancy after more than five weeks of preparation, represents an important advance in highly specialized maternal–fetal care. But this achievement also invites a vital question: how can we prevent more children from developing this condition in the first place?

Understanding the problem: more than a gap in the backbone

The condition treated was myelomeningocele, a severe form of spina bifida. It occurs when the developing neural tube—the structure that becomes the brain and spinal cord—fails to close properly. The spinal cord and its protective coverings can protrude through an opening in the backbone, leaving vulnerable nerve tissue exposed. Depending on the location and severity, children may experience leg weakness or paralysis, bladder and bowel dysfunction, and hydrocephalus, an abnormal accumulation of fluid in the brain.

Crucially, this problem begins very early. The neural tube normally closes within approximately 28 days after conception, often before pregnancy is recognized. Prevention must therefore begin before the first antenatal appointment—and ideally before conception itself.

A remarkable repair, not a complete cure

Fetal surgery aims to protect exposed nerve tissue from continuing damage during pregnancy; it does not recreate a normally developed spinal cord or guarantee freedom from disability. In open surgery, doctors open the mother’s abdomen and uterus, repair the baby’s spinal defect, close the uterus and allow the pregnancy to continue under close supervision.

The potential benefits are substantial. In the landmark 2011 Management of Myelomeningocele Study, the initial report found that 40% of children undergoing prenatal repair required a fluid-draining brain shunt by 12 months, compared with 82% after postnatal repair. Motor outcomes also improved. These findings concerned carefully selected pregnancies treated at experienced centers—not every baby with spina bifida.

The complexity deserves equal attention. This is major surgery involving both mother and fetus, not simply a technically impressive repair. Risks include premature rupture of the membranes, preterm birth and problems with the uterine scar. That scar also has implications for future pregnancies. Professional guidance therefore recommends careful selection, non-directive counselling and treatment only in appropriately equipped specialist centers.

AIIMS deserves appreciation for developing this capability. Nevertheless, completing the operation successfully is an early milestone, not proof of the child’s eventual neurological outcome. The reported plan for continued monitoring through pregnancy, delivery and the newborn period is essential; long-term multidisciplinary care may still be required.

Prevention: the intervention that must happen earlier

Many—but not all—neural tube defects can be prevented. A WHO evidence review found that folic acid taken around conception reduced neural-tube-defect-affected pregnancies by approximately two-thirds across the included trials. That is a population-level finding, not a guarantee for an individual pregnancy.

The practical priorities are clear:

• Start folic acid before pregnancy. For those at usual risk, the standard preventive dose is 400 micrograms—0.4 mg—daily. CDC advises starting at least one month before conception; WHO recommends supplementation from the time a woman begins trying to conceive until 12 weeks of pregnancy. Because the critical developmental window is so early, CDC also recommends daily folic acid for all women capable of becoming pregnant.

• Personalize care for higher-risk pregnancies. A previous neural-tube-defect-affected pregnancy warrants specialist preconception advice. WHO recommends 5 mg daily in this situation; US guidance recommends 4 mg. These higher doses should be clinician-directed, not self-prescribed.

• Review health conditions and medicines beforehand. Pre-existing diabetes, obesity, certain anti-seizure medicines—including valproate—and significant overheating or fever in early pregnancy are associated with increased risk. Preconception care should address glucose control, nutritional health, weight and medication safety. Medicines should be reviewed with the treating clinician, not stopped independently.

• Combine nutrition with reliable supplementation. A varied, folate-rich diet remains important, but preventive guidance recommends folic acid in addition to dietary folate. Fortified foods can help reach women before an unplanned pregnancy; checking labels matters because products differ.

Prevention must never become an excuse for blaming mothers. Spina bifida has genetic and non-genetic contributors, and folic acid does not prevent every case. An affected pregnancy is not evidence of parental negligence.

A public-health lesson beyond the operating theatre

The choice is not advanced surgery versus prevention. We need both: specialist treatment for affected babies, and accessible preconception counselling, folic acid supplies, appropriate food fortification and public education to reduce preventable cases. Fortification is particularly valuable because it does not depend entirely on a pregnancy being planned or a daily tablet being remembered.

AIIMS has demonstrated what coordinated medical expertise can achieve after a serious defect has developed. The wider healthcare system must show what timely prevention can achieve before it develops.

Let us celebrate the surgeons who protect a child’s future—and give equal attention to the preventive care that begins before that child is conceived.

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