Folic acid and the prevention of neural tube defects (NTDs). Challenges and recommendations for public health.

To outline specific challenges facing public health in Canada that need to be addressed to ensure that all women of childbearing years can attain optimal folate status for prevention of NTDs.The new Dietary Reference Intake (DRI) for folate was examined in terms of the literature on the effective form of the vitamin, the level of folic acid provided by the Canadian food supply and the folic acid content of available supplements.There are six major challenges facing public health in Canada on this issue. These include confusion among health professionals and the general public on the effective form of the vitamin, requirements, and the necessity of taking supplements. Further obstacles to ensuring optimal folate status in all women of childbearing age in Canada include the limited amounts of folic acid that are currently permitted in foods and the difficulties involved in identifying the amount of folic acid provided in these foods in relation to needs.These challenges must be addressed to enable women in Canada to make an informed choice about folic acid. This has the potential to prevent up to 70% of the 300 births affected by NTDs each year.