Experts urge the government to fortify flour with folic acid as upper limit deemed invalid

A new study reinforces calls for the Department of Health to approve the fortification of flour with folic acid in order to protect babies from having neural tube defects.

Anencephaly and spina bifida (collectively referred to as neural tube defects) are serious and relatively common birth defects, affecting 1 in every 500-1,000 pregnancies. In 1991 a Medical Research Council randomised trial showed that increasing folic acid intake immediately before and early in pregnancy prevented most cases of neural tube defects.

Despite successive recommendations from the Scientific Advisory Committee on Nutrition, the UK has not introduced mandatory fortification. One reason given is that this might lead to more people having a folate intake above an ‘upper limit’ suggested in 1998 by the US Institute of Medicine (IOM – now the National Academy of Medicine). However, the new research reveals that the IOM analysis was flawed and there is no need for an upper limit.

The new study published today in the Public Health Reviews shows that the IOM’s analysis was flawed.

Responding to the paper, Professor Neena Modi, President of the Royal College of Paediatrics and Child Health, said:

“Folic acid taken in the early stages of pregnancy will prevent around seven of 10 neural tube defects. This new research is a game changer for fortification in allaying concerns about exceeding an upper limit of 1mg/day.

“In the early stages of pregnancy when neural tube defects arise, many women do not know they are pregnant, others may be unaware of the importance of taking folic acid, or may forget, so fortification of flour, which is harmless if consumed by children and adults, is a logical answer to a problem which can have catastrophic consequences.

“Around 80 countries already fortify foods and report significant reductions in neural tube defects. It’s a move backed by royal colleges, including the RCPCH, in addition to food manufacturers and other experts. Government now needs to implement this simple, highly effective public health measure. ”