the communities integrate. In the mean time it is clear that we should direct our attention towards ensuring that those women at increased risk of fetal malformations are offered preconceptual advice and, in the case of neural tube defects, perhaps periconceptual vitamin supplementation.' They should also be encouraged to book early for antenatal care so that the relevant screening tests are available to them should they wish. LYN CHITTY R M WINTER Kennedy Galton Centre, Northwick Park

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... Harrow HA I 3VJ 1 Alberman E. Congenital malformations. Br ,Ved 7 1989;299: 1416. (9 December.) 2 Cuckle H, Wald N. The impact of screening for open ncural defects in England and Wales. Prenatal Diagnosis 1987:7:91-9. 3 Lumb KM, Congdon PJ, Lealman GT. A comparative review of Asian and British-born patients in Bradford, 1974-8. J7 Epidemiol Communite Health 1981;35:106-9. 4 Modell B, Ward RHT, Fairweather DVI. Effect of introducing antenatal diagnosis on reproductive behaviour of f;amilies at risk for thalassaemia major. BrMed7 1980;280:1347-5I. 5 Seller MJ, Nevin CG. Periconceptual vitamin supplementatiots and the prevention of neural tube defects in south-east England and Northern Ireland.