Preventing spina bifida

In 2021, the UK government announced the introduction of mandatory fortification of non-wholemeal wheat flour with folic acid.

The announcement came in the wake of work by the Medical Research Council (MRC) Vitamin Study Research Group.

They had found that folic acid supplementation for women around the time of conception reduced the risk of spina bifida and other serious neural tube defects (NTDs).

Groundbreaking study

The groundbreaking study has led to the addition of folic acid to staples in more than 80 countries.

10% of all the flour produced in the world is now fortified with folic acid.

It is estimated that pregnancies affected by NTDs could fall by more than a fifth in the UK.

Reducing the risk

Cases of spina bifida in new babies have declined sharply across the world following this groundbreaking research and subsequent government action globally.

The MRC study had aimed to determine whether supplementation with folic acid (a B vitamin) or a mixture of seven other vitamins around the time of conception, could prevent NTDs.

Protective effects of folic acid

The trial involved 1,800 women at high risk because of a previous affected pregnancy, of whom nearly 1,200 had a completed pregnancy.

The results showed that folic acid had a 72% protective effect and that the other vitamins had none.

The study authors firmly advised that the diet of all women who may bear children contain adequate folic acid, especially women who had had an affected pregnancy.

The study was published in The Lancet. Within weeks, the US Centers for Disease Control (CDC) recommended that women who had previously had an NTD pregnancy consume 4,000 micrograms of folic acid a day if planning a pregnancy.

Recommendations taken up across the world

A year later, the CDC recommended that all women capable of pregnancy consume 400 micrograms of folic acid a day to prevent NTDs.

Other countries followed with similar recommendations.

As recently as July 2021, New Zealand mandated fortification with folic acid.

In 2019, there was a public consultation in the UK on options for folic acid fortification and on 20 September 2021, the UK government announced the introduction of mandatory fortification.

Top image:  Credit: Olga Kazakova, iStock, Getty Images Plus via Getty Images

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