Anencephaly is an open neural tube defect, meaning that part of the neural tube does not properly close or that it has reopened during early embryogenesis. An embryo with anencephaly develops without the top of the skull, but retains a partial skull, including the face. Anencephaly is one of the most common birth defects of the neural tube, occurring at a rate of approximately one in one thousand human pregnancies. The condition can be caused by environmental exposure to chemicals, dietary deficiencies, or genetic mutations.
In 1931, physician Lucy Wills conducted a study of nutritional deficiencies that caused anemia in pregnant women in Bombay, India, later renamed Mumbai. Anemia is a lack of healthy red blood cells in the blood. Wills published the results of her study in the medical article 'Treatment of ‘Pernicious Anaemia of Pregnancy' and 'Tropical Anaemia'' in the British Medical Journal in 1931. Wills's research contributed to knowledge of anemia and the possible causes associated with the disease, such as the symptoms of fatigue and irritability. Wills attempted to connect the association of B vitamins and anemia. Wills's findings influenced scientists to research the importance of folic acid, one of the B group vitamins, and the role it plays in the development of a fetus and in women's health.
From 1993 to 1995 researchers led by Robert J. Berry from the US Centers for Disease Control headquartered in Atlanta, Georgia, and Zhu Li from Beijing Medical University in Beijing, China, conducted a collaborative study in China on the prevention of neural tube defects or NTDs using folic acid supplements. NTDs are birth defects in which openings in the spinal cord or the brain that occur during early development remain after birth. Neural-tube formation occurs in early pregnancy, often before a woman knows she is pregnant and therefore before she has begun taking prenatal vitamins. The researchers presented their findings in the article “Prevention of the Neural Tube Defects with Folic Acid in China” published in 1999 in The New England Journal of Medicine. The researchers from The China-US study found that women who took folic acid in the periconceptional period, or the time before conception through the first twenty-eight days after conception, reduced the occurrence of NTDs.