UCL: Enhanced Folic Acid Fortification Needed to Prevent Birth Defects

In the piece, published last night, Professor Wald (UCL Institute of Health Informatics) warns that the current government’s proposal to fortify only one type of flour (non-wholemeal wheat flour) at an inadequate level will prevent only about 20% of neural tube defects, much less than the approximate 80% that could be prevented with fully effective fortification.

“What the government has done is a useful step in the right direction, but it is not enough,” he says.

Neural tube defects (NTDs) such as spina bifida occur when a baby’s brain and spinal cord don’t develop normally. They are a major cause of late terminations, and also cause miscarriage, stillbirth and neonatal death as well as harm to the mother. Many children with spina bifida, one of the consequences of an NTD, endure lifelong disability.

Women wanting to conceive are advised to take a folic acid supplement before and during early pregnancy to help prevent NTDs, but evidence shows that most women either do not take them at all or take them too late to be effective.

Professor Wald led the international trial (the MRC Vitamin Study) that over 30 years ago definitively established the vitamin deficiency that is the main cause of neural tube defects.

In the BMJ article, he argues that fully effective fortification is a safe and relatively small change that would be of unquestionable public benefit; that it would have a profound positive health impact on the lives and livelihoods of people regardless of socio-economic status; and that it would also advance equality and social justice.

He welcomes the fact that the government has, at long last, accepted folic acid fortification as a necessity, but states that “there is simply no scientific basis to justify this partial remedy.”

Making fully effective fortification a health priority, no matter which party wins the election, should be a promise that the new government makes. Importantly, it must be a promise kept and delivered without delay, he writes.

The new government could do substantially better by adopting fully effective fortification with folic acid, he concludes. Political parties and politicians need to rise to the challenge and pass this “acid test”.