Vitamins During Pregnancy and Neural Tube Defects

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To the Editor.— In their article entitled "Multivitamin/Folic Acid Supplementation in Early Pregnancy Reduces the Prevalence of Neural Tube Defects," Milunsky and coauthors1suggest that recall bias or undercounting vitamin use in early pregnancy could have resulted in our study's2finding that vitamin and folate supplement use was not associated with a decreased risk for neural tube defects. We do not consider recall bias a problem in our study, however, becausemore than half the women who reported supplement use were able to locate the bottle and read us the ingredients, good evidence that the data are accurately reported. Milunsky et al state that most of their subjects did not know their pregnancy outcomes at the time of their interviews. However, it would be important to know how many women, especially those with neural tube defects, knew the results of their maternal serum α-fetoprotein screening tests before they were

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