Flour power: fortifying with folic acid to help prevent birth defects

UK health officials are calling for flour to be fortified with folic acid to help prevent birth defects. Will Ireland follow suit?

Expectant mothers have long been advised to avoid particular foods for the duration of their pregnancy. And it is also widely known that taking certain supplements can help promote good health and well-being for both the mum-to-be and her unborn baby.

But while everyone has good intentions, many simply forget to take the recommended vitamins which could be of great benefit to their growing infant.

The most commonly recognised and promoted supplement is folic acid, which is said to help reduce the risk of certain birth defects. But, currently, only one in four women take it before pregnancy – so health officials in the UK have put forward a motion to fortify flour with folic acid in a move to help reduce foetal abnormalities.

British public health minister Steve Brine said it would increase folate intake among pregnant women and in turn reduce their baby's risk of spina bifida and other birth defects. And England's chief medical officer Prof Dame Sally Davies said the evidence showed that "fortifying flour with folic acid is a practical way of reducing folate deficiencies in pregnant women and reducing birth defects".

“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,” she said. “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.”

Alison Wright, vice president of the Royal College of Obstetricians and Gynaecologists in the UK, says the college supports calls to fortify flour with folic acid. "The evidence is clear that fortification will prevent around half of the [1,000 diagnoses of] neural tube defects," she says. "Fortifying flour with folic acid is a simple, safe and evidence-based measure that will reach women who don't receive enough folic acid through their diet, as well as those who may not have planned their pregnancy."

‘No policy’

A spokesperson for the Department of Health said they were "aware of the UK media reports, but there is no policy currently in place in relation to folic acid food fortification".

So, in the absence of fortified flour for pregnant women in this country, Dr Cliodhna Foley Nolan of Safefood Ireland says all women who could become pregnant should make taking folic acid a daily habit, irrespective of whether they are planning a pregnancy or not. "The Safefood campaign 'Babies Know the Facts About Folic' reminds women that taking a folic acid supplement daily is the best way to reduce the risk of having a baby with a neural tube defect like spina bifida," she says.

“For a healthy mum and baby, the only way to get adequate levels of folic acid is by taking it every day as a 400 microgram supplement and making that a habit – taking a daily supplement is the only way to go. There has been some recent debate about fortification of foods with folic acid but this is still some way off. But even with fortified foods, taking the daily supplement provides best protection of the unborn baby’s spine and brain.”

Prof Michael Turner, UCD professor of obstetrics and gynaecology at the Coombe Women and Infants University Hospital says women should start folic acid before they become pregnant and not wait until they are planning a pregnancy or until after they become pregnant.

“Taking a 400 microgram folic acid supplement every day can potentially prevent two thirds of neural tube defects every year – on average, that’s approximately 50 fewer babies affected every year,” he says.

And Dr Rhona Mahony, former master of the National Maternity Hospital, Holles Street, agrees:

“We know that women are aware of the benefits of taking folic acid but with up to 50 per cent of all pregnancies being unplanned, it’s so important that all women who could become pregnant start taking it daily, even if a baby is the last thing on their mind,” she advises. “A baby’s neural tube develops in the first few weeks of pregnancy when many women may be unaware they are pregnant and for this reason they need to make folic acid part of their daily routine.”

In a recent online survey by Safefood, the most common barriers listed by women to taking folic acid were low relevancy to them (42 per cent); a lack of advice regarding folic acid (40 per cent); a belief that contraception was 100 per cent effective (37 per cent) and forgetting to take folic acid (30 per cent).

Couple of cents

But Foley Nolan says folic acid is widely available, doesn’t require a prescription and doesn’t cost more than a couple of cents a day.

“By taking it daily, women are taking control of their own health,” she says. “Taking it doesn’t mean you are planning a baby but it does mean that when you do have a baby, however unplanned or far in the future that may be, you are already helping to protect their health.”

And midwife Tracy Donegan says while folic acid is essential, natural folate is the best option.

"Most experts recommend taking 600 micrograms of folate daily to help prevent major birth defects of the baby's brain and spine," says the gentlebirth.ie founder. "Folic acid prevents these but it doesn't have the other health benefits of natural folate.

“Some folate is already found in foods but it can be difficult to get the recommended amount from your diet alone. For this reason, all women, and especially anyone planning a pregnancy, should consider taking a daily vitamin supplement that contains folate rather than folic acid whenever possible.”