Periconceptional folic acid and the prevention of neural tube defects: Some food for thought for Canadian paediatricians

OBJECTIVE: To review the data supporting the periconceptional use of folic acid for the prevention of neural tube defects and to explore how Canadian physicians can help foster preventive strategies. DATA SOURCES: Articles found through a MEDLINE search, 1990 to 1996, and Cochrane Database of Systematic Reviews 1995. Questionnaire survey of selected group of women of childbearing age (November 1994). Chart review of all children with newly diagnosed neural tube defects admitted to the Children's Hospital of Eastern Ontario, Ottawa, Ontario, between 1989 and 1994. DATA SELECTION: Epidemiological studies and randomized trials of supplemental folic acid for prevention of neural tube defects. Epidemio-logical studies and randomized trials of dietary folic acid. DATA SYNTHESIS: An increased periconceptional folic acid intake can prevent the recurrence of and the first occurrence of neural tube defects. However, consumption of adequate folic acid as natural food folate is relatively ineffective. Furthermore, few women are aware of the need for increased folic acid intake, despite Health Canada recommendations, nor do physicians seem to discuss the prevention of neural tube defects with patients. CONCLUSION: Better physician awareness, public education and supplementation of a staple food with folic acid are necessary to make the preventive strategy against neural tube defects effective.