CF4 4XNven today, the neural tube defects (NTD) with an incidence of over 4 per 1000 births in a number of regions of the United Kingdom are still one of the commonest and most tragic malformations at birth, though on the continent of Europe the incidence is less than half. This group of malformations which comprises anencephaly, encephalocele and spina bifida have a multifactorial aetiology where the genetic component is polygenic and environmental triggers are thought to set off the malformation in early development (Carter 1974). For women known to be at increased risk, prevention is, of course, possible by pregnancy avoidance after genetic counselling. Secondary prevention can be achieved by early renatal detection of NTD in women known to be at high isk, or after screening, followed by selective termination.inally, as little can be done to correct the genetic factors in the foreseeable future, true prevention of these defects would therefore be independent on identifying the environmental trigger factors and either eliminating or avoiding them. GENETIC COUNSELLING WOMEN WHO have previously had one affected child may run a risk of recurrence of I in 20, though there is evidence that in the last decade or so this recurrence risk has decreased appreciably (Laurence 1981;Seller, 1981;Seller and Hancock, 1985), along with the decrease in the population incidence (Bradshaw, Wheale and Weatherall, 1980). However, for those who have had more than one affected pregnancy, the chance of recurrence may be greater than 1 in 10. Couples with a close relative who has had an affected child will also run some risk but this is likely to be no more than 1 in 50 and often much less than that.In the past when no other approaches were available as *Partly based on the chapter by Laurence, K. M., James, N., Campbell, H. (1983), entitled &dquo;The role of improvement m the maternal diet and preconceptional folic acid supplementation m the prevention of neural tube defects&dquo; m 'Prevention of Spina Bifida and other Neural Tube Defects' Ed. Dobbing, J. Academic Press,