Dr. Koren Replies

To the Editor: I thank Dr. Freeman and colleagues for their thoughtful remarks. Our investigation into the folate status of women with schizophrenia emanated from the case of a woman taking olanzapine who experienced a very large weight gain and whose fetus had a large neural tube defect. Since the publication of our study of schizophrenia patients, Motherisk has initiated a prospective follow-up study of women with schizophrenia regarding folate status and other obstetric risks. Every woman with schizophrenia counseled by us, either while planning a pregnancy or while already pregnant, is offered a measurement of folate levels, counseling on supplementation, and repeated measurements to verify compliance, plus a screening for neural tube defects. The idea of Dr. Freeman and colleagues of investigating the dietary status of women is logical and important since other critical nutrients and micronutrients may also be lacking.