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The MRC Vitamin Study Research Group randomised control trial published in 19911 was the first clear demonstration that folic acid supplementation at the time of conception significantly reduces the probability of neural tube defects. Of course, mandatory supplementation of flour is only one of the possible approaches to increasing folate levels in women of childbearing age but with the high rate of pregnancies that are not planned, it is difficult to enable women to ensure that their folic acid levels are high at the time of conception using other forms of supplementation. Promotion of voluntary uptake of folate supplements has been of limited effectiveness and uptake tends to be poor in lower socioeconomic groups, who potentially have the most to gain from supplementation. Mandatory supplementation of flour with folic acid has been adopted as the preferred public health measure for the prevention of neural tube defects in many countries.
Since 1991, mandatory …
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