UK ‘one step closer’ to adding folic acid to flour for foetal health

Neural tube defects are severe birth defects of the brain and spine. According to the Centers for Disease Control and Prevention (CDC), they occur when the neural tube does not close properly.

The two most common neural tube defects are spina bifida (a spinal cord defect) and anencephaly (a brain defect).

Neural tube defects develop very early during pregnancy, often before a woman knows she is pregnant. However, prevention can be helped by including folic acid in the mother’s diet.

All women of reproductive age are urged to get 400 micrograms (mcg) of folic acid – otherwise known as folate or vitamin B9 – every day, in addition to consuming food with folate from a varied diet.

In the UK, not all women are consuming adequate amounts of folic acid in their diets. However, there is another way young mothers could increase their intake: via fortified bread.

Consultation now open​

The Department for Environment, Food & Rural Affairs (Defra) has already consulted with industry and stakeholders on the feasibility of adding folic acid to non-wholemeal flour.

Now, Defra is launching a consultation on the Bread and Flour Regulations, which aims to ensure the regulations are consistent with other food standards legislation. Specifically, the government is consulting on its proposal to add 250 micrograms of folic acid per 100 grams of flour.

The consultation aims to support UK industry, help lead to improved public health outcomes, assist enforcement authorities and protect UK consumers, explained Defra Food Minister Victoria Prentis.

“It will ensure the regulations are consistent with other food standards legislation, covering the specifications of vitamins and minerals added to foods.”​

Potential to reduce neural tube defects by one-fifth​

As it stands, neural tube defects affect around 1,000 pregnancies each year in the UK.

Adding folic acid will mean foods made with flour, such as bread, will actively help avoid around 200 neural defects each year – around 20% of the annual total.

“Neural tube defects can have a devastating impact on life expectancy and quality of life,” ​said Minister for Public Health Maggie Throup. “This simple step will ensure more women who might be pregnant, or who are trying to conceive, will have increased intakes of folic acid, leading to a large reduction in the number of foetuses affected by neural tube defects each year.”​

The consultation is now open and closes 23 November 2022.

Does folate fortification work?​

Public health policies relating to folate fortification have already been successful in Australia, New Zealand and Canada.

In Canada, folic acid fortification of all types of flour, enriched pasta, and cornmeal became mandatory in 1998. Already in 2007, less than 10 years on, a 46% reduction in neural tube defects was observed.

Australia introduced mandatory folic acid fortification of wheat flour for making bread in 2009. Since that time, the rate of neural tube defects has decreased by 14.4%, in line with predictions.

According to the Australian Institute of Health and Welfare, the decrease in neural tube defects has been most substantial for teenagers and Aboriginal and Torres Strait Islander women – the latter for which rates have fallen by 74%.

New Zealand is preparing for incoming legislation, whereby from mid-2023 onwards, all non-organic wheat flour used for bread making must be fortified with folic acid.