Folic acid and prevention of neural-tube defects

Association of the 677C-->T mutation on the methylenetetrahydrofolate reductase gene in Turkish patients with neural tube defects

We report the analysis of the 677C-->T mutation on the 5, 10-methylenetetrahydrofolate reductase gene in Turkish controls and cases of neural tube defects. Mutation analysis of 91 patients with neural tube defects, 72 mothers, 63 fathers, and 93 healthy controls has been made by polymerase chain reaction and allele specific restriction digestion with Hinf I. We did not find a significant difference in the 677C-->T allele and genotype distribution among the patients with neural tube defects, their parents, and the control group. This result suggests that another mutation in the folate-related enzyme genes could be responsible for neural tube defects in Turkey. None of the mothers of patients with neural tube defects was advised to use folic acid as recommended to prevent neural tube defects. An immediate attempt to establish an education program for healthcare providers and women of childbearing age is crucial in Turkey. Furthermore, fortification of foods with folate would be a better approach.

The prevention of neural tube defects

The prevention of neural tube defects is a complex problem. The genetic associations may ultimately allow the prepregnancy identification of women at high risk of a neural tube defect. Education of both the public and healthcare providers has been shown to increase awareness, but the majority of women do not take folic acid before and in the early part of pregnancy. Food fortification will be effective in increasing the folate levels of the population and will have a benefit even at low doses of fortification.