Folic acid fortification consultation

The Government has announced that it will consult on the mandatory fortification of flour with folic acid in a bid to reduce pregnancies effected by neural tube defects (NTD).

Adequate levels of folic acid are required during the first 12 weeks of pregnancy to ensure the proper formation of the foetal neural tube that connects the brain and spinal cord. Inadequate levels of folic acid before and during pregnancy have been linked to an increased risk of foetal neural tube defects (NTDs) such as anencephaly, spina bifida and encephalocele.

On 23rd October, Public Health Minister Steve Brine announced that the government would consult on making it mandatory to fortify flour with folic acid to reduce the number of NTD pregnancies. Fortification of flour with folic acid is not uncommon, if the government approves these plans the UK will fall in line with the other 80 countries, including US, Canada and Australia, where fortification is already mandatory.

Since 1991, women planning a pregnancy have been advised to take a daily 400µg folic acid supplement from pre-conception through to the end of the first trimester to reduce the risk of NTDs. However, almost half of pregnancies in the UK are unplanned meaning many are not taking supplements and therefore not receiving sufficient folic acid. According to the NDNS, 91% of women of childbearing age were below the threshold for red blood cell folate concentration, indicating an increased risk of NTDs.

According to a UK study, only a third of women take folic acid supplements before pregnancy and a European study found that less than 20% of women know that folic acid could reduce the risk of NTDs. This is reflected in the prevalence of NTD in the UK, 1.28 in 1000 pregnancies are effected (equating to 700-900 effected pregnancies each year) causing avoidable terminations, stillbirths, neonatal deaths and permanent disability. A recent modelling study suggested that mandatory fortification could prevent 200-300 NTD pregnancies each yeah in the UK.

Health ministers have been pushing for mandatory fortification for some years but it has previously been contested by the Food Standard Agency (FSA). In 2002 they had concerns over the potential masking effects fortification may have on vitamin B12 deficiency and possible increased risk of colon cancer. Since then SACN have found no significant evidence to suggest that supplementation increased the risk of cancer. Both SACN and FSA have now recommended mandatory fortification on the basis that controls on voluntary fortification should be put in place to prevent exceeding tolerable levels in certain groups.

Chief Nutritionist at Public Health England, Alison Tedstone has said: “Fortifying flour with folic acid is an effective and safe measure to reduce the number of pregnancies affected by neural tube defects.”

Professor Dame Sally Davies, Chief Medical Officer for England has said:

“The evidence shows that fortifying flour with folic acid is a practical way of reducing folate deficiencies in pregnant women and reducing birth defects.”

“However, as with any intervention of this kind, we need to be certain it is also safe, and that means considering what the wider implications would be for the rest of the population who eat flour.”

“I am pleased to see the government taking action on this issue and hope to see the wider scientific community feed in their views to this important consultation which could benefit and improve the lives of many women and babies in this country.”

The consultation will take place in early 2019 and will take into consideration the evidence, practicality and safety of mandatory fortification.

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