Ray and colleagues raise an important point on folic acid fortification. This is a very contentious subject, with well developed battle grounds.
Folic acid fortification is advocated to prevent or reduce the incidence of foetal neural tube defects in babies. A terrible blight for those afflicted.
Folic acid fortification was universally introduced in Canada in 1998 , the result was a 50% reduction in foetal neural tub defects.
However why has the figure not dropped to zero?
The authors show that 35% of neural tube defects in Canada may be a result of maternal deficiency of vitamin B12.
7.4% of pregnant women tested in a study in Ontario had a reduced serum B12 concentration.
Clearly an important trial is required here of vitamin folic acid and folic acid plus B12 supplementation
Ray et al 2008 High rate of maternal vitamin B12 deficiency nearly a decade after Canadian folic acid flour fortification QMJ vol 101 475-477. .

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