A new study, published in the Archives of Disease in Childhood journal, has revealed that the UK should follow the folic acid supplementation schedule recommended in the United States. All women of childbearing age should take 44 micrograms of folic acid a day.
In 1998, the FDA specified that all food manufacturers had to fortify flour including cereals, pasta, rice and other grain products with folic acid.
Researchers in the British study analyzed data from the British Isles Network of Congenital Anomaly Registers (BINOCAR) to assess the number of NTDs (neural tube defects) and associated terminations of pregnancy that occurred in the UK between 1991-2012.
The statistics reveal that NTDs occur in 1.28 per 1,000 births between 1991-2012 and 81% of these pregnancies were terminated. There was a 23% reduction in prevalence of pregnancies with NTDs in the US between 1998-2012 – after mandatory fortification of flour with folic acid was introduced.
The research team estimated that 2,014 fewer pregnancies with an NTD could have been avoided between 1998-2012 if the UK had adopted the same fortification policy as the United States.
The scientists estimate that unless Britain adopts mandatory fortification of flour with folic acid, there will be an additional 150 pregnancies with an NTD each year, around half of which will be due to spina bifida without anencephaly, according to the researchers who label the failure to fortify as a “public health failure”.
“Justifiably, steps were introduced to immediately halt the epidemic, and regulatory precautions were introduced to avoid another similar epidemic,” the researchers said. “Unfortunately, no such sense of urgency has been applied to the prevention of spina bifida.”
“It is illogical to take preventive public health action to avoid a drug-induced congenital anomaly, but to largely ignore action in relation to a congenital anomaly which can be prevented by vitamin fortification of flour, when the failure to act has resulted in, and continues to result in, many more serious cases. It is a public health failure that Britain has not implemented the fortification of flour with folic acid for the prevention of spina bifida and other NTDs.”
Prevention of neural tube defects in the UK: a missed opportunity, Joan Morris et al., Archives of Disease in Childhood, doi:10.1136/archdischild-2015-309226, published online 17 December 2015, abstract.
The BMJ news release, accessed 17 December 2015.