Comment

Mandatory fortification of flour with folic acid could improve lives of women and babies

After the United States experienced considerable success after fortifying flour with folic acid, surely it is time the UK followed suit.
Folic acid

Fortifying flour with folic acid has seen a significant reduction in the number of babies born with neural tube defects in the United States. It is time the UK adopted the same policy, says Yana Richens.

Research published earlier this month (July 2016) in the Drug and Therapeutics Bulletin found that pregnancy multivitamins do not boost the health of mothers and babies.

Fortification of flour with folic acid is good news for women. Picture: iStock

The researchers set out to examine current UK guidance for vitamin supplements recommended for pregnant women, and the evidence behind it, by reviewing the published research on folic acid, vitamin D, iron, vitamins C, E and A, and multivitamin supplements.

Although taking multivitamins in pregnancy did

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Fortifying flour with folic acid has seen a significant reduction in the number of babies born with neural tube defects in the United States. It is time the UK adopted the same policy, says Yana Richens.

Research published earlier this month (July 2016) in the Drug and Therapeutics Bulletin found that pregnancy multivitamins do not boost the health of mothers and babies.

Folic acid
Fortification of flour with folic acid is good news for women. Picture: iStock

The researchers set out to examine current UK guidance for vitamin supplements recommended for pregnant women, and the evidence behind it, by reviewing the published research on folic acid, vitamin D, iron, vitamins C, E and A, and multivitamin supplements.

Although taking multivitamins in pregnancy did not translate into better outcomes for mother and baby, the researchers found benefits with folic acid and vitamin D, both of which are recommended and should be taken during pregnancy. 

The researchers are absolutely spot on. Taking 400 micrograms of folic acid can protect against neural tube defects in the developing baby, and 10 micrograms a day of vitamin D is recommended for healthy bones in both mother and baby.

Unforeseen pregnancies

But as the majority of pregnancies are unplanned, not all women are taking the recommended amount of folic acid, which is required up until 12 weeks of pregnancy.  

What can be done about this? Simply fortify flour with folic acid like they do in the United States and the 77 other countries that have a policy in place to do this. The US has seen neural tube defects decline by 28% since the introduction of flour fortification. 

Only this year researchers pointed out that if the US levels of folic acid fortification from 1998 onwards had been adopted in the UK, an estimated 2,014 fewer neural tube defect pregnancies would have occurred.

Action long overdue

The UK does not have a policy of fortifying flour with folic acid, despite evidence that it can cut the risk of neural tube defects by about 70%. What is shocking is that we have known about this since 1991 – more than two decades ago. 

The suffering experienced by women and babies due to failure to implement folic acid fortification is avoidable. This is not rocket science – fortification of flour with folic acid should be a UK public health policy priority. Babies and women deserve better. 

Further reading: 

Morris J K et al (2016) Prevention of neural tube defects in the UK: a missed opportunity. Archives of Disease in Childhood. doi:10.1136/archdischild-2015-309226

Yana Richens is consultant midwife public health, University College London Hospital and global adviser (consultant), Royal College of Midwives

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