Bread and flour should be fortified with folic acid in the UK to help prevent babies from being born with neural tube defects such as spina bifida, according to new research.



A study by Queen Mary University of London and the School of Advanced Study at the University of London concludes that there is no need for an upper limit of folate intake.

Anencephaly and spina bifida – together known as neural tube defects – are serious and relatively common birth defects, affecting one in every 500-1,000 pregnancies in the UK. 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.

As a result, 81 countries – including the United States since 1998 – have introduced mandatory folic acid fortification of cereals, which has been found to reduce the prevalence of neural tube defects without any evidence of harm.

Despite successive recommendations from the Scientific Advisory Committee on Nutrition, the UK has not introduced mandatory fortification. This could be down to fears that it might lead to more people having a folate intake above an “upper limit” suggested by the US Institute of Medicine (IOM). However the latest research, published on Wednesday in Public Health Reviews, concludes that the IOM analysis is flawed and that there is no need for an upper limit.

At present, women in the UK who are considering becoming pregnant are advised to start taking a daily folic acid supplement but most do not do so – particularly younger and ethnic minority women.

“Failing to fortify flour with folic acid to prevent neural tube defects is like having a polio vaccine and not using it,” said lead author Professor Sir Nicholas Wald from the Wolfson Institute of Preventive Medicine at Queen Mary. “With the upper limit removed there is no scientific or medical reason for delaying the introduction of mandatory folic acid fortification in the UK.”

Every day in the UK, an average of two women terminate a pregnancy because of a neural tube defect, while every week two women give birth to a baby affected by one.

Professor Neena Modi, president of the Royal College of Paediatrics and Child Health, said the new research was “a gamechanger for fortification … government now needs to implement this simple, highly effective public health measure.”