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Neural Tube Defect Cluster Stresses Importance of Folic Acid Supplements

JAMA. 2013;310(17):1787. doi:10.1001/jama.2013.280228.
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A cluster of infants born with neural tube defects in Washington State has prompted a reminder for physicians about the importance of folic acid supplements for women of childbearing age and the risk of birth defects linked with nitrate concentrations in private well water.

In August 2012, the Washington State Department of Health was alerted to an excessive number of anencephaly births at a hospital in the central part of the state. The health department’s investigation showed that 27 women in a 3-county area had pregnancies affected by neural tube defects between January 2010 and January 2013. Anencephaly affected 23 of the pregnancies, spina bifida affected 3, and encephalocele, 1. The anencephaly rate in the 3-county area was 8.4 per 10 000 live births compared with a national rate of 2.1 per 10 000 live births. In contrast, the spina bifida rate was 1.3 per 10 000 live births compared with 3.5 per 10 000 nationally.

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