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Preventing neural tube defects

BMJ 2000; 321 doi: (Published 15 July 2000) Cite this as: BMJ 2000;321:176

Analysis is less than thorough

  1. Lucy Thorpe, programme manager,
  2. Paul Lincoln, director
  1. Folic Acid Programme, Health Education Authority, London SW1P 2HW
  2. Northern Congenital Abnormality Survey, Maternity Survey Office, Newcastle upon Tyne NE2 4AA
  3. Royal Free and University College Medical School, Department of Obstetrics and Gynaecology, London NW3 2PF

    EDITOR—Kadir et al are less than thorough in their analysis of efforts to promote awareness and increased consumption of folic acid among women of childbearing age and the issues involved.1 The public education campaign run by the Health Education Authority began in February 1996, after the government's original strategy of exhorting doctors and nurses to give this new advice proved to be failing. It cannot be expected (bearing in mind the human reproductive cycle) that public health initiatives will have any effect on the incidence of neural tube defects in the same year they are launched; yet Kadir et al quote 1996 data to judge the effect of such efforts.

    They discuss the sale and prescribing of folic acid supplements as markers for increased consumption of folic acid. Yet they are unclear whether their quoted data refer only to supplements licensed as medicines, or also to unlicensed supplements, which are classified as food supplements and account for a large proportion of, if not most, folic acid preparations sold over the counter.

    The ultimate test of such a public health initiative is, however, whether it affects the incidence of neural tube defects. Kadir et al acknowledge that a longer interval may be required to show the true effect of supplementation on the incidence of neural tube defects. They did not have long to wait for data indicating such an effect. Only a few days …

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