To the Editor.
—The Jan 22/29 issue of JAMA contains a STATE OF THE ART/REVIEW about neural tube defects (NTD) by Dr Lemire.1 This review presented some interesting ideas, eg, the separation of neurulation and postneurulation defects. However, I was surprised to read that "worldwide, an average prevalence of one case per 1000 births for both anencephaly and meningomyelocele exists, but France, Norway, Hungary, Czechoslovakia, Yugoslavia, and Japan have a low prevalence (0.1 to 0.6/1000 births)."In Hungary, epidemiologic studies provide valid and complete birth prevalences of different congenital anomalies. During the 1960s the birth prevalences per 1000 total births of anencephaly and meningomyelocele (spina bifida cystica) were 1.03 (isolated and multiple cases, 1.10) and 155 (1.63), respectively, while those of encephalocele and congenital hydrocephalus were 0.20 (0.22) and 0.57 (0.76), respectively.2 The birth prevalences of neurulation defects, ie, anencephaly and spina bifida cystica, decreased to 0.9 and