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The review shows clear evidence of a substantial reduction of low serum and red cell folate levels, of megaloblastic erythropoiesis and overall improvement in haemoglobin levels with routine folate supplementation in women who are not anaemic. However, there is uncertainty regarding any effects, beneficial or harmful, of routine folate supplementation on short-term clinical outcomes for mother and baby. The reviewer recommends routine folate supplementation in countries where megaloblastic anaemia is common, such as in endemic malaria regions.

It is noted that periconceptional folic acid supplementation, which has been recommended for the prevention of neural tube defects, is outside the scope of this review and hence it is neither reviewed nor discussed.

Twenty-two trials have been included in the review of routine folate supplementation in pregnancy, though control of 'selection bias' was often difficult to assess, as many authors did not specifically describe the technique of randomization. The reviewer has included only those trials in which the groups were comparable with respect to other forms of supplementation, i.e. if both experimental and control groups received iron and anti-malarials.

Overall, all adequately controlled trials that could be identified have been included. The reviewer has appropriately emphasized the methodological limitations of the studies and the methodology used in the review seems to be rigorous and the trial characteristics are presented in detail.

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