Spina bifida risk factors

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1. Maternal nutrition factors:

Alcohol use

Caffeine use

Low folate intake

Low dietary quality

Elevated glycaemic load or index

Low methionine intake

Low serum choline level

Low serum vitamin B12 level

Low vitamin C level

Low zinc intake

Smoking

Hyperthermia

Low socio-economic status

Maternal infections and illnesses

Pregestational insulin-dependent diabetes

Pregestational obesity

Psychosocial stress

Valproic acid use

2. Environmental factors

Ambient air pollution215,216

Disinfectant by-products in drinking water217

Indoor air pollution218

Nitrate-related compounds219

Organic solvents220

Pesticides221,222

Polycyclic aromatic hydrocarbons223