The way it is

Spina bifida and folic acid

Every year hundreds of pregnant women are told that their babies have a neural tube defect like spina bifida.

Some of these babies will die before they are born, others will die shortly after birth, and others are aborted by mothers in deep emotional and moral anguish.

Many who survive face a range of challenges that will test their mettle to the limits.

Neural tube defects

In the UK, around 600 pregnancies are estimated to be affected by neural tube defects (NTDs) every year. If the mothers-to-be had received folic acid supplements before and during the early stages of pregnancy, that figure could have been slashed by up to two thirds.

Spina bifida, one of the most common and probably best known NTD, occurs when one or more of the bones which form the backbone do not develop properly, leaving a gap or a split. Children can suffer from hydrocephalus (water on the brain) and varying degrees of paralysis.

In the US and Canada

In both the US and Canada, the mandatory fortification of flour with folic acid was introduced in 1998. Chile followed suit in 2000. These countries have reported reductions of between 27 per cent to more than 50 per cent in the rate of pregnancies affected by NTDs.

In the UK

The UK government published findings and issued guidelines and then largely stood back and relied on women to know in advance when they were about to become pregnant, to know how much and for how long they should be taking folic acid, to buy their own supplements and to use the correct dose.

But not all pregnancies are planned and, despite various publicity initiatives, not everyone is aware of the importance of taking folic acid. A MORI poll commissioned by Action Medical Research as recently as October 2000, showed that just 56 per cent of women of childbearing age were aware of the health benefits of folic acid for unborn babies. And a mere 15 per cent followed the government's advice on taking supplements both before and during the early stages of pregnancy.

The official line

Since 1992, the UK's leading health authorities have been advising women to take 0.4mg (400mcg) supplement of folic acid every day immediately after stopping contraception, and for the first 12 weeks of pregnancy. Many women do. But clearly many do not.

According to figures presented by the UK Department of Health's own Committee on Medical Aspects of Food and Nutrition Policy (COMA) in 2000, around 175 babies are born in the UK with an NTD each year. So, using this figure as a rough guide, we can estimate that between 1992 - when the government began issuing advice to women on the importance of daily doses of folic acid for planned pregnancies - and 2005, some 2,275 babies will have been born with an NTD like spina bifida.

Some of these babies may well have been born with an NTD whether or not their mothers had followed the guidelines on folic acid supplements. But how many would have been spared by the addition of folate to the flour their mothers ate? For years, many groups have been calling for the fortification of flour with folic acid in the UK.

In 2000, COMA concluded that adding folic acid to flour would significantly reduce the number of pregnancies and births complicated by NTDs. Despite this advice, the Government's Food Standards Agency rejected the recommendation.

Scientific Advisory Committee on Nutrition

Now, the Scientific Advisory Committee on Nutrition (SACN) has issued a draft report recommending the mandatory fortification of flour with folic acid. The SACN says it believes the benefits of increasing levels of folic acid in people's diets would outweigh any risks.

Comments from interested groups have been requested by the SACN which then hopes to submit its final report to the UK Government in spring 2006.

Action Medical Research has welcomed the draft report from the SACN and hopes that the Government will make it's decision on the fortification of flour with folic acid based on the balance of scientific evidence available.

Are there problems with the fortification of flour?

In 2002, the UK Government rejected recommendations to fortify flour with folic acid on the grounds that it could lead to increased folic acid intakes in the general population which might mask the early symptoms of vitamin B12 deficiency in the elderly.

Vitamin B12 deficiency

Vitamin B12 deficiency is relatively common in people aged over 65 years and is usually caused by a failure of the gut to absorb B12. Left unchecked, a lack of this vitamin can lead to anaemia and irreversible damage to the nervous system.

However, the SACN has pointed out in its draft report, that as long as steps are taken to give extra B12 to those at risk, adding extra folic acid to flour need not pose a health risk to older people.

The SACN says that the management of vitamin B12 deficiency in those over 65 years needs to be assessed whether or not the mandatory fortification of flour with folic acid is introduced.

The Action Medical Research link

Our research established inital link

The folic acid debate is very dear to our hearts at Action Medical Research. It was funding from our charity which enabled the initial link between taking folic acid and the prevention of spina bifida to be established.

FSA recommendations due in the autumn

We are delighted that the Food Standards Agency (FSA) has taken note of the SACN recommendation and in April 2006 announced that it would be reviewing the options for increasing the amount of folate in the diets of young women. Fortification of flour is among the options being evaluated. Building on a 12-week consultation exercise starting in May, the FSA expects to make its final recommendations to Health Ministers in late autumn this year.

Raising awareness

In the mean time, Action Medical Research will be trying to raise awareness among women of the need to begin taking folic acid supplements as soon as possible before starting a family and during early pregnancy to help give their babies the best start in life.