The prevention of neural tube defects is a complex problem. The genetic associations may ultimately allow the prepregnancy identification of women at high risk of a neural tube defect. Education of both the public and healthcare providers has been shown to increase awareness, but the majority of women do not take folic acid before and in the early part of pregnancy. Food fortification will be effective in increasing the folate levels of the population and will have a benefit even at low doses of fortification.