- Nicholas J Wald,
- Carol Bower
- Professor Visiting research fellow Department of Environmental and Preventive Medicine, Wolfson Institute of Preventive Medicine, Medical College of St Bartholomew's Hospital, London EC1M 6BQ
A population strategy is needed
Over three years have passed since an increase in the intake of folic acid among women planning a pregnancy was shown to prevent most neural tube defects.1 The evidence is conclusive; prevention is effective for women who have not had a pregnancy in which the fetus had a neural tube defect as well as for those who have.2 National authorities have recommended that women planning a pregnancy should increase their intake of folic acid.3 4 5 The extra folic acid needed for a reasonable protective effect is 0.4 mg a day, twice the current average dietary intake of 0.2 mg. If no screening was carried out for neural tube defects (with subsequent abortions) about 1500 affected children would be born each year in Britain. Over 1000 of these defects could be prevented by women consuming extra folic acid. Sadly, most people are still not aware of the importance of folic acid in the prevention of neural tube defects.6 7 A public health initiative is urgently needed; the tragedy of a pregnancy in which the fetus has a neural tube defect is even greater when it can be so easily prevented.
Some people argue that preventive strategies should be selectively targeted at women planning a pregnancy—on the grounds that only pregnant women and their children stand to benefit and only a few of these are affected. From a public health perspective, however, most disorders affect only a minority of people at risk …