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Mandatory fortification of flour to prevent fetal anomaly in pregnancy

1) Why will mandatory fortification of flour with folic acid help pregnant women?

It is recommended that all pregnant women take folic acid supplements in order to prevent the neural tube defects that cause serious fetal anomalies such as spina bifida and anencephaly. This is only really effective if a woman takes it before she becomes pregnant as the neural tube closes in the very early stages of pregnancy, often before a woman has missed her first period.

As 46% of pregnancies in the UK are unplanned, and many women are unaware of the need to take folic acid, most pregnant women with the best of intentions will start taking folic acid too late in pregnancy to protect their baby from avoidable harm. Fortifying flour with folic acid would means that it would enter foods widely consumed by women of childbearing age, so women will already be consuming the vitamin prior to becoming pregnant.

A number of countries, including the USA, Canada and Australia, which have introduced mandatory fortification of flour, have seen a marked reduction in neural tube defects with no evidence of adverse effects on the rest of the population. Research published in the Lancet in 2013 ruled out any link between folic acid supplementation and cancer, drawing a line under this concern. Fortification would have an enormous impact on the small proportion of women who receive a diagnosis of serious fetal anomaly in a wanted pregnancy, and then need to terminate the pregnancy or give birth to a baby with a life-threatening condition.

While many fetal anomalies are not preventable, those caused by folic acid deficiency in early pregnancy are. This presents a compelling case for the Government to enact the Independent Scientific Advisory Committee on Nutrition's recommendation to fortify flour with folic acid in order to get the best possible pregnancy outcomes for women and their babies.

2) How do we know there is a problem in England?

The most recent report by the British Isles Network of Congenital Anomaly Registers (BINOCAR) indicates that we have a higher rate of neural tube defects than other European countries, particularly in younger mothers.

3) Who supports the call for mandatory fortification of flour with folic acid?

The Independent Scientific Advisory Committee on Nutrition and the Food Standards Agency recommend mandatory fortification of flour with folic acid to prevent serious abnormality in pregnancy.

The National Association of British and Irish Millers confirm that that they are happy to undertake fortification if asked to by the Government. The UK has been adding calcium, thiamin, niacin and iron to wheat flour for more than 50 years so both the principles and the mechanics of fortification are already in place. BPAS joins groups such as SHINE (formerly Association for Spina Bifida and Hydrocephalus) in calling for Government action to reduce these avoidable defects through a simple public health intervention.

'Women's awareness and periconceptional use of folic acid: data from a large European survey', April 2013

'Effects of folic acid supplementation on overall and site-specific cancer incidence' January 2013

BINOCAR, September 2013