Epidemiology

Failure of the embryonal neural tube to close normally between 24 and 28 days after conception gives rise to a group of severe congenital malformations known as NTDs that includes spina bifida, anence-phalus (approximately 50 and 40% of cases, respectively), encephalocoele, and iniencephaly. These anomalies are believed to be caused by an interaction of genetic predisposition and environmental factors, and many different factors have been pursued. Evidence of the importance of nutrition has accumulated since the 1960s, and the key role of folate/folic acid in the pathogenesis of these malformations was demonstrated conclusively in 1991.

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