Looking for causes of neural tube defects: where does the environment fit in?

The neural tube defects anencephaly and spina bifida are important causes of infant mortality and morbidity. Recent studies suggest that many of these defects can be prevented by the periconceptional use of folic acid. At the same time, we do not know what causes most cases of neural tube defects and there is evidence to suggest that they are etiologically heterogeneous. Additional research needs to be directed toward the role of occupational and environmental exposures in the etiology of these defects. Importantly, studies need to examine embryologically and anatomically specific types of defects and develop accurate information on biologically relevant exposures. Exposures toward which attention needs to be directed include organic solvents; agricultural chemicals, including pesticides; water nitrates; heavy metals such as mercury; ionizing radiation; and water disinfection by products. We also recommend that additional attention be paid to mechanisms of neural tube closure and to the potential role of genetic heterogeneity in the absorption and metabolism of xenobiotics and in their effects on the neural tube.