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Vitamins During Pregnancy and Neural Tube Defects-Reply

Aubrey Milunsky, MD, DSc; Hershel Jick, MD; Susan S. Jick, MPH; Kenneth J. Rothman, DrPH; Walter Willett, MD
JAMA. 1990;263(20):2748-2749. doi:10.1001/jama.1990.03440200049015.
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In Reply.—  First, there is substantial evidence in this population of women that there is little difference in the reported multivitamin (MV)/folate use when comparing women who were at low risk for an NTD baby with those who were at high risk. Among all women who had only a maternal serum α-fetoprotein determination (low-risk women), 45% reported a history of MV/folate intake in the first 6 weeks of pregnancy, compared with 53% among those who had amniocentesis (high-risk women). Among study women with no family history of NTD (low risk), the use of MV/ folate in the first 6 weeks of pregnancy was 47%, compared with 48% among women with a family history of NTD (high risk). The results indicate that, if anything, high-risk women were slightly more likely to report MV/folate use than were low-risk women. If this were bias, it would be in the direction of elevating the


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