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Neural tube defects and fortification.

Supplementing a woman's diet with folic acid reduces her chances of having a child with a neural tube defect. This has been shown in experimental and observational studies and for the last 15 years all women have been encouraged to take folate periconceptually.

But this message has failed to have the desired effect, even in developed countries, so foodstuff fortification has been implemented by adding folic acid to staple foods such as flour, corn meal and pasta in the milling industry. In the case of Canada, this was a decade ago so data are now available showing the effects of this national intervention.

De Wals et al. (NEJM 2007; 357: 135-142) report a halving of the prevalence of neural tube defects after fortification. Dividing their results into regions, they noted that the largest reductions were in the previously worst affected area and these reductions coincided with the years when fortification was introduced around 1998. The actual figures for Canada dropped from 1.6 to 0.9 per 1 000 births.

They do not report untoward side-effects. Their results strengthen the argument for fortification policies or more imaginative methods such as adding folic acid to oral contraceptive pills.
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Title Annotation:THE BEST OF THE REST: A summary of some of the best recent landmark articles from the international journals
Publication:South African Journal of Obstetrics and Gynaecology
Article Type:Report
Geographic Code:1CANA
Date:Oct 1, 2007
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