Preventing neural tube defects in Europe: population based studyBMJ 2005; 330 doi: https://doi.org/10.1136/bmj.330.7491.574 (Published 10 March 2005) Cite this as: BMJ 2005;330:574
All rapid responses
We read with interest the article by Busby et al  reporting the poor efficacy of current folic acid supplementation strategies in 16 European countries in reducing the prevalence of neural tube defects.
Data from our recent studies have demonstrated that despite an increased awareness of the benefits of folic acid, many women are failing to take supplements in the critical peri-conception period . In a cohort of women attending an antenatal clinic in Cumbria during 2002, less than 48% of women took folic acid before 4 weeks of gestation. Eighty nine percent of women took folic acid prior to their 18 week antenatal visit, suggesting that part of the public health message is being assimilated, although not for the important peri-conception period. These data suggest that there is considerable support for the use of folic acid among pregnant women but current supplementation strategies are simply unable to counter the issue of unplanned pregnancy.
Furthermore, women with a self-reported family history of neural tube defect-affected pregnancy were no more likely to have taken folic acid during the subsequent pregnancy despite the recommendation for such women to take 5mg of folic acid per day.
Our recent data also show that increased social deprivation is associated with both decreased folic acid use  and with decreased red blood cell folate status in early pregnancy (Relton, unpublished data). The prevalence of neural tube defects is greater in lower socioeconomic groups . Thus, current supplementation strategies are perpetuating this health disparity by preferentially benefiting socioeconomically advantaged women.
Taken together these observations lend further support to the comments of the authors for the adoption of a folic acid fortification programme that would increase folic acid intake of all women of childbearing age, regardless of socioeconomic status.
1. Busby A, Abramsky L, Dolk H, Armstrong B, Eurocat Folic Acid Working Group. Preventing neural tube defects in Europe: population based study. BMJ 2005:330:574-5.
2. Relton CL, Hammal DM, Rankin J, Parker L. Folic acid supplementation and social deprivation. J Public Health Nutr. 2005, in press.
3. Little J, Elwood H. Socio-economic status and occupation. In: Elwood JM, Little J, Elwood H, eds. Epidemiology and Control of Neural Tube Defects. Oxford: Oxford University Press, 1992.
Competing interests: None declared
Competing interests: No competing interests