South African Medical Journal

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Review of current evidence for folate in the prevention of neural tube defects

Rhena Delport, Johan B Ubbink


The incidence of neural tube defects (NTD) among black South Africans living in urban areas is low compared with reports of NTD incidence in rural areas  A NTD incidence of 0.95 per 1000 live births was reported in Cape Town,l while an incidence of 0.99 per 1 000 live births was reported in a study performed at Kalafong Academic Hospital, Pretoria.' In contrast, the prevalence of NTD in the black population in rural Transkei was 6.13 per 1 000 live births,' and in rural Northern Province it was 3.55 per 1 000 live births.' In view of the association between folic acid status and NiD, we  performed a study in rural and urban communities to determine whether folate or vitamin B12 status and/or abnormal homocyst(e)ine metabolism could explain why the incidence of NTD in rural areas is so high. (Homocyst(e)me (tHcy) refers to the sum of concentrations of free homocysteine, protein-bound homocysteine, the disulphide homocystine, and the mixed disulphide homocysteine-cysteine.)

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