HOW EFFECTIVE ARE CURRENT FOLIC ACID RECOMMENDATIONS FOR PREVENTING THE FIRST OCCURRENCE OF AN NTD?
Implementing the current recommendations for preventing the first occurrence of an NTD is problematic for various reasons. The first difficulty is that in some cases the recommendation is aimed at women planning a pregnancy (3). However, an estimated 50% of pregnancies in the United Kingdom and the United States are unplanned (3, 6) and the malformations of NTDs occur during the fourth week postconception, usually before a pregnancy is confirmed. Thus, to be effective, any intervention aimed at preventing NTDs should be targeted to all women of childbearing age so that optimal periconceptional folate status can be achieved in the majority of those who may become pregnant. A second problem in implementing the recommendation of an extra 400 µg/d from folate or folic acid supplements is that this amount represents a 3-fold increase in typical intakes of the vitamin, which are 200 µg/d in women (7 9). Thus, achieving the recommendation by food folates alone would require major dietary modi
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