To the Editor.

The commentary by Brent et al in the October 2000 issue ofPediatrics has a title that should invoke no disagreement: “The Unnecessary Epidemic of Folic Acid-Preventable Spina Bifida and Anencephaly.” The authors allowed for the association of valproic acid exposure and maternal insulin-dependent diabetes making up a portion of the neural tube defects, but the vast majority were attributable to folic acid deficiency. Or, at least, prevention was associated with folic acid intake. The folic acid issue seems to be: “How much and in what form?”

Supplementation was evaluated with varying reliability, from a telephone survey to data from countries with higher compliance rates than could be expected in this country. Whether a study was based on intake from natural folic acid sources, suboptimal supplementation, the accepted standard of 400 μg/day, enrichment of flour with 200 versus 400 μg, or whether supplementation was started before conception...

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