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In 1998, folic acid fortification of white flour, enriched pasta, and cornmeal became mandatory in Canada. The goal of fortification was to increase folic acid intake among women of childbearing age and thereby help prevent neural-tube defects (NTDs) in their offspring.
Data from nearly 2 million live births, stillbirths, and pregnancy terminations in seven Canadian provinces from 1993 to 2002 show that folic acid fortification was associated with a 46% decrease in NTDs. The greatest reductions occurred in regions with the highest baseline rates of NTDs. Although fortification in the U.S and Canada occurred at about the same time, it led to a greater reduction in NTDs in Canada, perhaps because of the lower baseline prevalence of NTDs in the…