Should We Be Putting Folic Acid in Our Flour?

Taking care of your wellbeing during pregnancy is one of the first steps you can take to support family wellness. Your doctor will tell you to take certain supplements such as folic acid, to prevent your baby’s risk of being born with a neural tube defect (birth defects that can affect the brain, spine and spinal cord), such as spina bifida. However, a UK study has found that just a third of women report taking folic acid before pregnancy, which has prompted calls for flour to be fortified with folic acid.


If your baby’s wellness is affected by spina bifida, it means he or she can suffer from learning difficulties, paralysis of the lower limbs and bladder and bowel incontinence. Therefore, it is recommended that you take a 400 microgram folic acid tablet every day while trying to get pregnant and until you are 12 weeks pregnant (or, if your baby was a happy surprise, you should take folic acid as soon as you find out you are pregnant). However, the study found only a third of women were taking this recommended amount, and that young women were less likely to take folic acid than older women, and non-white women were less likely to take folic acid than white women. As a result of these findings, the researchers have called for food in the UK to be fortified with folic acid. This is a practise that already occurs in the US, Canada and Australia, but could be met with resistance if actually proposed by UK politicians and policy makers.


It’s important to point out that the study, which was carried out by researchers from the Wolfson Institute of Preventive Medicine, was given no support or funding to report and there were no competing interests. The cross-sectional survey covered women who had antenatal screening for Down’s syndrome and neural tube defects at the Institute between 1999 and 2012. These women were asked if they had started taking folic acid supplements before pregnancy, once the pregnancy was confirmed or if they hadn’t taken folic acid supplements. The researchers also accounted for:

  • if women had previously had a neural tube defect pregnancy
  • if women had previously had a Down’s syndrome pregnancy
  • the woman’s ethnicity, weight, age and if she smoked
  • if the women had diabetes
  • if the women had got pregnant using IVF
  • where the women lived
  • time of screening (first or second trimester)


The results of the study, which were published in the peer-reviewed journal PLOS One, revealed that the proportion of women taking folic acid supplements before pregnancy had declined, from 35% over the 1999-2001 period to 31% over 2011-12. Moreover, just 6% of women aged under 20 took folic acid supplements before pregnancy compared with 40% of women aged 35 and over. 17% of Afro-Caribbean, 25% of Oriental and 20% of South Asian women took folic acid supplements, compared with 35% of Caucasian women. In addition, women who had a previous neural tube defect pregnancy or a previous Down’s syndrome pregnancy were more likely to take folic acid supplements before the current pregnancy (51% and 54% respectively, compared to just 30% of women who had not had either pregnancy.)


So how did the researchers interpret the results? The study investigators commented, ‘The policy of folic acid supplementation is failing and has led to health inequalities. This study demonstrates the need to fortify flour and other cereal grain with folic acid in all countries.’ The Food Standard Agency, the Scientific Advisory Committee on Nutrition and the Chief Medical Officers have all recommended fortification, and this is being considered by UK health ministers.

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