The Medical Research Council vitamin study has unequivocally demonstrated in 1991 that 72 percent of recurrence of neural tube defects (meningomyelocele and anencephaly) were successfully prevented by taking 4 mg of folic acid periconceptionally. Of 87 countries whose major staples were forti¿ed with folic acid, micronutrients, or minerals, 81 have implemented food forti¿cation with folic acid and observed a significant decline of neural tube defect prevalence following the fortification program. The Ministry of Health and Welfare in Japan recommended in 2000 that women planning to conceive should take folic acid supplements of 400 μg daily. During the past 16 years, however, prevalence of meningomyelocele has not decreased but remains rather stable, from 5 to 6 per 10,000 births (live births and stillbirths). A total of 542 newborns, i.e., 502 with meningomyelocele and 40 with anencephaly, were estimated to be born in the year of 2015. Furthermore, if fetuses terminated during pregnancy were counted, the real number of them would probably climb up to 2169 and would be 4 times as many as the number of¿cially reported. Since longstanding recommendations alone have not worked properly, we would like to urge the government to implement mandatory food forti¿cation with folic acid, which will certainly decrease the number of afÀicted patients and lead to economic bene¿ts and signi¿cant reduction in the cost burden on the healthcare system and healthcare payers.
