Folic acid use plummets, risking birth defect prevention

Fewer than one in five women in England are taking folic acid supplements before pregnancy, a notable decrease from one in four just five years ago. This worrying trend could jeopardize recent advancements in preventing severe birth defects linked to insufficient folic acid intake. Though the UK government mandated folic acid fortification of non-wholemeal wheat flour starting December 2026, the level added is insufficient to eliminate the need for supplements.

Folic acid is crucial for neural tube development in early pregnancy, preventing conditions such as spina bifida and anencephaly. The neural tube closes around four weeks after conception, often before a woman knows she is pregnant. This timing emphasizes the importance of pre-pregnancy supplementation, especially for unplanned pregnancies.

The decline in folic acid use is more pronounced among Black and Asian women, those in deprived areas, and specific regions like the north-east. Factors influencing uptake include lack of awareness, reliance on diet alone, and accessibility issues. Previous pregnancies can also lead to reduced supplement use in subsequent ones.

Mandatory fortification, implemented in countries like the US and Canada, has proven effective in reducing neural tube defects. However, the UK's planned fortification level of 0.25mg per 100g flour is estimated to prevent only about 20% of defects. Concerns also exist that public awareness of fortification might lead some to believe supplements are no longer necessary.

To fully address the issue, a comprehensive strategy is needed. This includes effective population-wide fortification, alongside timely education, care, and support for women before and between pregnancies. This combined approach aims to ensure optimal protection against birth defects for all women planning pregnancy.