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April 25, 1977

Prenatal Diagnosis of Neural Tube Defects-Reply

JAMA. 1977;237(17):1824. doi:10.1001/jama.1977.03270440014003

In Reply.—  It appears that the proper note has been struck in the second sentence of Dr Milunsky's letter, which acknowledges our detailing of prenatal diagnosis. In our opinion, there is a generalized deficiency in the reporting of details of diagnosis for neural tube defects in the United States. With this deficiency, the very promising use of the α-fetoprotein assay in a specific clinical protocol is becoming greatly endangered.The 1.2% false-positive diagnosis rate reported by those at the Shriver Center1 is unacceptable to families who have already experienced the tragedy of having a child with a neural tube defect. The emphasis of our report and subsequent work2 has always focused on a first-hand team approach to the diagnosis of neural tube defects. By using this comprehensive approach, we have now evaluated more than 150 high-risk families against a background experience of more than 3,000 pregnancies. Within this