1 Report for SHINE

Reduced folate status is now accepted as the most important risk factor for the occurrence (and recurrence) of NTD affected births (MRC Trial 1991). Consistent with this is a study that shows a graduation in risk in going for a reduced to an optimal folate status (Daly et al 1995). This study showed that in the index pregnancy (i.e. one in which the child had an NTD) there was a progressive relationship where the risk for mother with the lowest folate status was 7 per 1,000 births, reducing in a consistent way to where at an optimum folate status the risk had gone down tenfold to 0.7 per 1000 births. A further study (Daly et al 1997) showed that as little as 200 ug of extra folic acid per day could bring about a change in status from the highest to the lowest risk. These studies are consistent with the now wellestablished reduction in risk seen earlier in intervention trials and subsequently with folic acid fortification (MRC Trial 1991).