Questions concerning the possible association of potatoes and neural‐tube defects, and an alternative hypothesis relating to maternal growth and development

The hypothesis concerning the possible association of potatoes and neural‐tube defects has been reviewed. The bulk of epidemiological evidence presented to date fails to support this hypothesis. An alternative hypothesis is proposed for the etiology of anencephalus and spina bifida involving the interaction of three categories of causal factors: genetic, immediate, which pertains to the pregnancy in question, and intergenerational, which pertains to the growth and development of mothers of affected children. The epidemiological evidence is reviewed that supports an intergenerational concept, and includes the socio‐economic gradient, secular and geographic Variation, and migrant studies. The hypothesis is consistent with the complex epidemiological patterns that have emerged, and raises the question of the relevance of reliance on specific teratogens as the sole extragenetic explanations for these malformations. It is more likely that these defects are truly multifactorial in origin and relate to a complex interplay of biological and social factors rather than to single teratogens.