title: Primary prevention of neural-tube defects and some other congenital abnormalities by folic acid and multivitamins: history, missed opportunity and tasks.
abstract: The history of intervention trials of periconception folic acid with multivitamin and folic acid supplementation in women has shown a recent breakthrough in the primary prevention of structural birth defects, namely neural-tube defects and some other congenital abnormalities. Recently, some studies have demonstrated the efficacy of this new method in reducing congenital abnormalities with specific origin; for example, in the offspring of diabetic and epileptic mothers, and in pregnancy with high fever. The benefits and drawbacks of four possible uses of periconception folate/folic acid and multivitamin supplementation are discussed: we believe there has been a missed opportunity to implement this preventive approach in medical practice. The four methods are as follows: (i) dietary intake of folate and other vitamins, (ii) periconception folic acid/multivitamin supplementation, (iii) food fortification with folic acid, and (iv) the combination of oral contraceptives with 6S-5-methytetrahydrofolate ('folate').
authors.affiliation: Törökvész lejtõ 32, 1026 Budapest, Hungary.
authors.forename: Andrew E
authors.initials: AE
authors.lastname: Czeizel
authors.affiliation: Department of Pulmonology, Elisabeth Teaching Hospital, Sopron, Hungary.
authors.forename: Zoltán
authors.initials: Z
authors.lastname: Bártfai
authors.affiliation: Second Department of Obstetrics and Gynecology, Semmelweis University, School of Medicine, Budapest, Hungary.
authors.forename: Ferenc
authors.initials: F
authors.lastname: Bánhidy
keywords: cardiovascular malformations; contraception; folic acid; multivitamins; neural-tube defects; prevention
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