Thirty three years ago Hibbard and Smithells linked folate deficiency in pregnancy with neural tube defects.Smithells then led a series of observational and intervention studies which showed that improving folic acid status early in the pregnancy of mothers who had previously had a child with neural tube defects reduced the recurrence in that pregnancy.A randomised trial by Britain's Medical Research Council confirmed that finding and a Hungarian trial showed a reduction in the first occurrence too.To reach almost all women in the very early stages of pregnancy, when few would be sure they were pregnant, folic acid fortification of a staple food has been advocated, and a Department of Health committee has now recommended universal fortification of flour in the United Kingdom. Though the benefits are clear, the possible harms of such a policy are not. We need to be cautious in implementing a universal policy.
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