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We focus on a recent recommendation by the World Health Organization that a specific \u201coptimal\u201d red blood cell (RBC) folate concentration be used as the sole indicator of NTD risk within a population and discuss how to best apply this guidance to reach the goal of assessing NTD risk globally. We also emphasize the importance of using the microbiologic assay (MBA) as the most reliable assay for obtaining comparable results for RBC folate concentration across time and countries, the need for harmonization of the MBA through use of consistent key reagents and procedures within laboratories, and the requirement to apply assay\u2010matched cutoffs for folate deficiency and insufficiency. To estimate NTD risk globally, the ideal scenario would be to have country\u2010specific population\u2010based surveys of RBC folate in WRA determined utilizing a harmonized MBA, as was done in recent studies in Guatemala and Belize. We conclude with guidance on next steps to best navigate the road map toward the goal of generating reliable folate status data on which to assess NTD risk in WRA in low\u2010 and middle\u2010income countries.<\/jats:p>","DOI":"10.1111\/nyas.13511","type":"journal-article","created":{"date-parts":[[2017,11,15]],"date-time":"2017-11-15T08:26:39Z","timestamp":1510734399000},"page":"82-95","source":"Crossref","is-referenced-by-count":31,"title":["Folate status in women of reproductive age as basis of neural tube defect risk assessment"],"prefix":"10.1111","volume":"1414","author":[{"given":"Lynn B.","family":"Bailey","sequence":"first","affiliation":[{"name":"Department of Foods and Nutrition, College of Family and Consumer Sciences University of Georgia  Athens Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dorothy B.","family":"Hausman","sequence":"additional","affiliation":[{"name":"Department of Foods and Nutrition, College of Family and Consumer Sciences University of Georgia  Athens Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2017,11,15]]},"reference":[{"key":"e_1_2_12_2_1","unstructured":"Word Health Organization.2015.Guideline: optimal serum and red blood cell folate concentrations in women of reproductive age for prevention of neural tube defects.Geneva:World Health Organization."},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.3945\/jn.111.141515"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/nyas.13532"},{"key":"e_1_2_12_5_1","unstructured":"World Health Organization.2015.Serum and red blood cell folate concentrations for assessing folate status in populations. 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