Information on the role of periconceptional intake of folic acid is not sufficiently disseminated to young women and health-care professionals alike. Pregnant women should be repeatedly recommended to take folic acid supplements of 400 microg/day.

Four risk factors were identified among Japanese women. Because recommendations and information have not decreased the occurrence of spina bifida, the Japanese government should implement mandatory food fortification.

The average intake of dietary folate did not fulfill the Recommended Dietary Allowance of 440 µg. Serum folate concentration significantly increased only among pregnant women who took folic acid supplements. Recommendations to consume balanced diets do not seem effective to decrease the incidence of neural tube defects.

As a whole it could be stated that life styles of pregnant women have been shifting toward the direction the past 10 years where the risk for having a pregnancy afflicted with spina bifida is to be decreased. Medical doctors, nurses, midwives, dietitians and pharmacists are asked to repeatedly supply important information on folic acid and to advise taking folic acid supplements 400 microg a day to women planning to conceive or women in the reproductive age.