We thank Godfrey Oakley for his comments on our article1 and agree that current folic acid fortification levels may be inadequate. Unfortunately, it is difficult to determine the lowest level needed to minimize the occurrence of open neural tube defects; some suggest that there is no need for fortification, although others recommend as much as 350 mg/100 g of grain. A consensus will be difficult to achieve. Meanwhile, it is important that further population-based studies on the effects of fortification be undertaken not only to help determine such a level but also to rule out theoretical adverse effects. It is also important to continue advocating periconceptual folic acid supplementation and sound nutrition.
Michiel C. Van den Hof Vidia L. Persad Department of Obstetrics and Gynaecology Dalhousie University Halifax, NS
Reference
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