A large, prospective, population-based cohort study in China (N = 567,071 couples) observed that folic acid supplementation started three months prior to conception may reduce the risk of NTDs (OR = 0.55, CI: 0.39-0.82, p=0.003) and clefts (OR = 0.59, 95% CI: 0.36-0.95, p=0.029 (54)
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Their mechanisms are complementary and the reasoning is coherent, but the combination has never been directly tested