On the 14 October 2018 it was reported that government ministers would support a plan to fortify flour in the UK with folic acid in the coming weeks.

However, on the 23 October it was then announced that the government would launch a consultation into the fortification of flour with folic acid in early 2019.

Just two days later on World Spina Bifida and Hydrocephalus Awareness Day, parliament debated the announcement. The response from ministers was overwhelmingly positive with many speakers questioning why this hasn’t been done sooner.

Folic acid is a B vitamin found naturally as folate in foods such as green leafy vegetables. It is used to make DNA, form red blood cells, and help nerves to function properly.

In pregnancy, women require more folic acid to aid their growing foetus’ nervous system development, with the primary requirement being in the first 12 weeks as the foetus’ spinal cord and brain form.

If mothers have insufficient folate during pregnancy, then the risk of the foetus developing a neural tube defect is much higher. This is where the spine does not close properly – leading to spina bifida or anencephaly.

Anencephaly is the absence of a large portion of the brain and skull, and makes up 40 percent of neural tube defects, which can be fatal. Neural tube defects affect around 1000 pregnancies each year in the UK, and where not fatal have other damaging consequences.

Women are advised to take folic acid supplementation of 400mg per day before conception and up to week 12 of pregnancy. However, the latest national diet nutrition survey statistics suggests that 91 percent of women of childbearing age have low folate levels.

It is estimated that in just 50 percent of planned pregnancies mothers take folic acid supplements. In unplanned pregnancies this figure is substantially lower. With the risk highest in the first few weeks of pregnancy, this leaves a huge number of expectant mothers and babies at risk.

Furthermore this is an area hugely impacted by health inequality. Wealthy women are more likely to take supplements than poorer women and those of ethnic minorities. Just six percent of women under 20 supplement their diet in pregnancy. Fortification would help to cover these groups.

It is estimated that 85 other countries have implemented mandatory fortification of flour with folic acid; Canada reported a 50 percent reduction in cases of neural tube defects since their introduction.

Concerns over fortification include individuals ‘overdosing’ on folic acid, although several recent studies have shown that previous upper limits of folic acid intake are no longer applicable.

Another worry is the potential to mask B12 deficiencies until they are significantly worse, but this has not been shown to be a problem in the US.

Folic acid fortification has the potential to prevent thousands of babies being born with neural tube defects and is widely supported by Spina Bifida charities, doctors and the Royal College of Obstetrics and Gynaecology. If implemented, this could be a large and overwhelmingly positive change for the UK and its public health policies.


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