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Vitamins During Pregnancy and Neural Tube Defects

Mary J. Seller; Norman C. Nevin
JAMA. 1990;263(20):2749. doi:10.1001/jama.1990.03440200049016.
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Tb the Editor.—  We were interested to read the article by Milunsky et al,1 which demonstrated that multivitamins with folic acid, taken in the first 6 weeks of pregnancy, are associated with a significant reduction in the birth prevalence of neural tube defects (NTDs). We congratulate the authors on a fine piece of work.This prospective population occurrence study complements well the intervention study by ourselves and our colleagues,2 which has consistently shown a reduced recurrence of NTDs in at-risk women specifically given multivitamins and folic acid supplementation in the periconceptional period. Milunsky et al note that their results differ from a retrospective case-control study by Mills et al,2 which showed no positive effect on NTDs of periconceptional multivitamins, and they suggest two reasons. We wish to propose a third, the evidence for which we find apparent in our study.The effects of vitamin therapy are more


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