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The UK urgently needs a public health strategy for NTD reduction, which could include the use of food supplements, food fortification or a combination of both. An updated nutritional benefit-risk analysis is needed to inform population-based and/or targeted public health policies for folic acid intake and reduction of risk of neural tube defects. Policymakers should be cautious about the long-term exposure of the population as a whole to additional folic acid, especially potential adverse effects on the nervous system and brain function in older people, and higher levels of intake during infancy and childhood. The European-wide authorised health claim for folic acid food supplements and reduced risk of NTDs could transform the communication of the health benefits for women of childbearing age. Vitamin B12 deficiency may be an independent risk factor for NTDs, in which case dietary interventions with folic acid combined with vitamin B12 need to be considered.