A randomised controlled double-blind trial was undertaken in south Wales to prevent the recurrence of neuraltube defects in women who had had one child with a neural-tube defect. Sixty women were allocated before conception to take 4 mg of folic acid a day before and during early pregnancy and 44 complied with these instructions. Fifty-one women were allocated to placebo treatment. There were no recurrences among the compliant mothers but two among the non-compliers and four among the women in the placebo group. Thus there were no recurrences among those who received supplementation and six among those who did not; this difference is significant (p =--0 04).It is concluded that folic acid supplementation might be a cheap, safe, and effective method of primary prevention of neural-tube defects but that this must be confirmed in a large, multicentre trial.

A randomised controlled double-blind trial was undertaken in south Wales to prevent the recurrence of neuraltube defects in women who had had one child with a neural-tube defect. Sixty women were allocated before conception to take 4 mg of folic acid a day before and during early pregnancy and 44 complied with these instructions. Fifty-one women were allocated to placebo treatment. There were no recurrences among the compliant mothers but two among the non-compliers and four among the women in the placebo group. Thus there were no recurrences among those who received supplementation and six among those who did not; this difference is significant (p =--0 04).It is concluded that folic acid supplementation might be a cheap, safe, and effective method of primary prevention of neural-tube defects but that this must be confirmed in a large, multicentre trial.

SUMMARY This paper reports a study of cafe-au-lait spots of a minimum diameter of 1 cm in 732 white schoolchildren. Three groups were identified, according to the number of cafe-au-lait spots on each child: (1) those with none (74%), (2)

Summary and conclusionsOne hundred and seventy-four women who had previously had a child with a neural-tube defect were assessed retrospectively on the quality of their diets during the first trimester of that pregnancy, between pregnancies, and during the first trimester of other pregnancies. They were then studied prospectively during the first trimester of 186 following pregnancies and the outcome of these was recorded. One hundred and three women (with 109 pregnancies) were given dietary counselling before the pregnancy, the remaining 71 (with 77 pregnancies) not being counselled. Seventyeight (72%) of the counselled women improved their diet compared with only nine (12%) of the uncounselled women. The difference was significant (p <0 001). There were three recurrences of neural-tube defects in the counselled women (3%) and five recurrences in the uncounselled (7%). Although this difference was not significant, the relative risk in the counselled group was reduced to less than half of that in the uncounselled group. All eight recurrences occurred in the 45 pregnancies in women taking poor diets (18%), whereas there were no recurrences in the 141 other pregnancies.This difference is significant (p <0 001).It is concluded that women receiving adequate diets have a lower incidence and recurrence of fetal neuraltube defects than women receiving poor diets and that dietary counselling may be effective in reducing the incidence of fetal neural-tube defects. IntroductionThe incidence of fetal neural-tube defects in all surveys carried out in the British Isles has consistently been greater in mothers in social classes 4 and 5 than in those in social classes 1 and 2,'-5 though more recently this difference has been less pronounced, possibly reflecting the general improvement in the standard of living.3 A relation undoubtedly exists between social class and maternal diet, with several studies showing that mothers in social classes 4 and 5 more often have a poor diet in early pregnancy and sometimes suffer from deficiencies of essential dietary constituents.6 With this in mind we undertook a study of the diet of women who had had pregnancies complicated by fetal neural-tube defects as part of a larger survey of the possible biochemical abnormalities during early pregnancy of women who were at increased risk of such pregnancies. We report here some of the findings of the dietary part of the study together with the effect of dietary counselling.

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