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Implications for Prevention

Leslie E. Daly, PhD; Peadar N. Kirke, FFPHMI; Anne Molloy, PhD; Donald G. Weir, MD, FRCP; John M. Scott, DSc

JAMA. 1995;274(21):1698-1702.

Abstract
Using data from a recent case-control study, a woman's risk of having a child with a neural tube defect (NTD) was found to be associated with early pregnancy red cell folate levels in a continuous dose-response relationship. These findings were used to calculate the reduction in NTD cases that would be expected under two different strategies to raise folate levels. Targeting high-risk individuals has a small effect on the population prevalence but can substantially change an individual's risk. Targeting the population produces a small change in individual risk but has a large effect on the population prevalence. Supplementation of high-risk women would be the most efficient method to implement the high-risk strategy, while food fortification would be preferable for the population approach. The current guidelines for the prevention of NTD are for an increased folic acid intake of 0.4 mg per day. This would result in a 48% reduction in NTDs, which may be near optimal. The two intervention strategies should be considered complementary in prevention of NTDs.

(JAMA. 1995;274:1698-1702)

Author Affiliations
From the Department of Public Health Medicine and Epidemiology, University College Dublin (Ireland) (Drs Daly and Kirke); Health Research Board, Dublin (Dr Kirke); and Departments of Clinical Medicine (Drs Molloy and Weir) and Biochemistry (Dr Scott), Trinity College Dublin.

Footnotes
Reprint requests to Department of Public Health Medicine and Epidemiology, University College Dublin, Earlsfort Terrace, Dublin 2, Ireland (Dr Daly).

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