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Folic Acid and Prevention of Spina Bifida-Reply

Godfrey P. Oakley Jr, MD, MSPM; J. David Erickson, DDS, PhD; Myron J. Adams Jr, MD
JAMA. 1996;275(21):1636. doi:10.1001/jama.1996.03530450026021.
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In Reply.  —Folic acid has been shown in randomized controlled trials to prevent 50% to 70% of spina bifida and other NTDs. As a result of this evidence, the US Public Health Service recommends that all women capable of becoming pregnant consume 0.4 mg of folic acid per day.1 The Centers for Disease Control and Prevention estimates that if all women followed the recommendation, there would be 2000 to 3000 fewer pregnancies affected by spina bifida and related defects each year in the United States. On March 5, 1996, the US Food and Drug Administration issued a rule that will require, by 1998, the addition of folic acid to all enriched cereal grain products.2 Fortification will be a very important public health action, providing American women an opportunity to increase their consumption of folic acid.Despite our enthusiasm for cereal grain fortification, it will be difficult for women


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