Folic acid supplementation: more work is needed
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* James K. Friel

We are pleased that data presented by the group led by Natalie Björklund, Jane Evans and Cheryl Greenberg support our results showing a high risk for neural tube defects in Newfoundland.1 If we had applied the less conservative interpretation suggested by Booth and colleagues2 to our data, our results would have indicated that even more Newfoundland women were at risk.

It is clear from the work of Björklund and colleagues and from our own experience that public education in this area has been truly neglected, to the detriment of all Canadian women. Canadian women are simply not going to get the 400 μg/day of folate needed to prevent neural tube defects from a normal diet. Folate fortification at current levels is not sufficient to meet dietary goals, let alone reduce the incidence of neural tube defects. Furthermore, there is no evidence that public health attempts to raise the awareness of women of child-bearing age about the necessity of taking a dietary folate supplement to prevent neural tube defects have been successful.

Data from a Chinese study confirm unequivocally that just 400 μg/day will nearly eliminate this disease.3 As health professionals we are morally obligated to push forward these findings to our policy-makers and to our patients.

## References

1.  1. House JD, March SB, Ratnam S, Ives E, Brosnan JT, Friel JK. Folate and vitamin B12 status of women in Newfoundland at their first prenatal visit. CMAJ 2000;162(11):1557-9.
    
    [Abstract/FREE Full Text](http://www.cmaj.ca/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6NDoiY21haiI7czo1OiJyZXNpZCI7czoxMToiMTYyLzExLzE1NTciO3M6NDoiYXRvbSI7czoyMzoiL2NtYWovMTYzLzkvMTEyOS4yLmF0b20iO31zOjg6ImZyYWdtZW50IjtzOjA6IiI7fQ==) 

2.  2. Booth CK, Clark T, Fenn A. Folic acid, riboflavin and vitamin B-6 status of a group of first-time blood donors. Am J Clin Nutr 1998; 68(5):1075-80.
    
    [Abstract/FREE Full Text](http://www.cmaj.ca/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6NDoiYWpjbiI7czo1OiJyZXNpZCI7czo5OiI2OC81LzEwNzUiO3M6NDoiYXRvbSI7czoyMzoiL2NtYWovMTYzLzkvMTEyOS4yLmF0b20iO31zOjg6ImZyYWdtZW50IjtzOjA6IiI7fQ==) 

3.  3. Berry RJ, Li Z, Erickson JD, Li S, Moore CA, Wang H, et al. Prevention of neural-tube defects with folic acid in China. N Engl J Med 1999; 341:1485-90.
    
    [CrossRef](http://www.cmaj.ca/lookup/external-ref?access_num=10.1056/NEJM199911113412001&link_type=DOI) 
    
    [PubMed](http://www.cmaj.ca/lookup/external-ref?access_num=10559448&link_type=MED&atom=%2Fcmaj%2F163%2F9%2F1129.2.atom) 
    
    [Web of Science](http://www.cmaj.ca/lookup/external-ref?access_num=000083625800001&link_type=ISI)