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Folic Acid and Prevention of Birth Defects

Andrew E. Czeizel, MD
JAMA. 1996;275(21):1635. doi:10.1001/jama.1996.03530450025018.
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To the Editor.  —Dr Daly and colleagues1 present an important article about the relationship of red cell folate levels to neural tube defect (NTD) risk. If all women achieved a 100% increase in red cell folate (ie, a doubling), which could certainly be achieved by taking an extra 0.4 mg folic acid per day, a 48% total NTD reduction would occur. However, the question now is how to respond to this new knowledge. To improve the motivation of women planning pregnancies, as Daly et al suggested: "It is also worthwhile noting that a population increase in folic acid intake may also have a protective effect on heart disease, cervical cancer, and colorectal cancer." In addition, there is a third group of arguments that is related to the reduction of other structural birth defects.2The final data set of the Hungarian randomized, double-blind controlled trial indicated that folate not


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