Abstract
Neural tube defects (NTDs) are severe, often lethal, congenital malformations of the spine and central nervous system, the most common of which are spina bifida, anencephaly, and encephalocele. NTDs are among the most common and preventable birth defects in the United States. Still, every year in North Carolina, about 1 in every 500-700 pregnancies is affected by an NTD. 1 For reasons we don’t yet understand, the rate of NTDs is higher in the Southeastern states, including North Carolina, than in the rest of the country. Some specific causes (single gene or chromosomal disorders, maternal diabetes, valproic acid use, and hyperthermia) have been identified, but in most cases no specific etiology is identifiable. 2 It is well documented that women who take a daily dose of the B-vitamin folic acid before conceiving can reduce the risk of NTDs by up to 70%. 3-6 Because the neural tube closes by the fourth week after conception, it is important that folic
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