There is no doubt that folic acid (also known as vitamin B9) is an essential vitamin in pregnancy.
For the mother, it can help prevent the development of conditions such as anaemia and it is even more crucial to the unborn baby’s development. Folic acid is proven to prevent neural tube defects such as spina bifida, where the baby’s spine does not develop properly, and anencephaly, where a significant portion of the skull and brain doesn’t form. The neural tube develops during the first 12 weeks of pregnancy, and for this reason, medical professionals advise women to take 4mg of folic acid (or 5mg if they have certain risk factors) daily when trying to conceive as well as during the first trimester.
Dr Jonathan Pearson Stuttard’s article offers lots more information if you’d like to know more about all the benefits of taking folic acid supplementation in pregnancy.
As Dr Pearson-Stuttard mentions, there are still many women who do not take the supplement during pregnancy despite being advised to do so and informed of the risks, which has led to a total of 81 countries, including the US, to fortify flour with folic acid as a mandatory requirement since 1998. The UK and EU countries, however, are yet to follow their lead. But this could be on the verge of changing.
With many medical experts calling again for the UK to fortify flour with this all-important vitamin, it appears as though the government has finally listened. Theresa May, who was initially opposed to the change, has now backed a plan for folate supplement to be added to food, and it is starting to look more likely than ever that mandatory fortification will be introduced. The government plans to consult on the matter in early 2019.
All the signs so far point to the government being strongly in favour of the change. Public health minister Steve Brine has told the House of Commons the “evidence is overwhelming that this is something that we should be doing”.
During the consultation, ministers will be looking at evidence to determine whether there is a safe upper limit of folate levels, giving full consideration to whether fortification is the best thing to do for the population as a whole. The government is expected to reach a decision in the spring of 2019.
Mr Brine is certainly right about the overwhelming evidence; research shows that the UK has one of the highest incidences of neural tube defects in the whole of Europe – something that is surely unacceptable given that many cases are preventable. Defects linked to folate deficiency cause two terminated pregnancies a day, and overall, according to the Royal College of Obstetricians and Gynaecologists (RCOG), neural tube defects are diagnosed in around 1,000 pregnancies each year. Speaking for the RCOG, Dr Alison Wright, the College’s vice president, said, “The evidence is clear that fortification will prevent around half of these neural tube defects.”
Earlier in the year, research from the Queen Mary University of London concluded that, since 1998, an estimated 3,000 neural tube defects in the UK could have been prevented if the UK had introduced mandatory fortification at the same time as the US. Responding to these findings, Professor Nicholas Ward from the Wolfson Institute of Preventative Medicine said that “failing to fortify flour with folic acid to prevent neural tube defects is like having a polio vaccine and not using it”.
This sentiment is expressed elsewhere in the medical community. Speaking for the Royal College of Midwives, Clare Livingstone, professional policy advisor, said that mandatory fortification would help women who may not be aware they are pregnant receive a sufficient amount of folic acid from conception to the 12th week of pregnancy. “Many pregnancies are not planned, meaning many women will not have taken folic acid around the time of conception and very early in their pregnancy,” Livingstone said.
Clare Murphy, the director of external affairs at the British Pregnancy Advisory Service, is another advocate for fortification, calling it a “straightforward public health intervention which will spare hundreds of women the heartbreak of receiving the news that their baby has a serious condition”.
So, with health professionals strongly in favour of mandatory fortification of flour, it appears as though this could well be a reality next year, which is wonderful news for future mothers and their babies.
For further reading, My BabyManual has plenty of information on how you can get essential pregnancy vitamins through your diet, helping you towards a healthy pregnancy with minimal complications.