Consultation on fortifying flour with folic acid

The government plans to consult on the mandatory fortification of flour with folic acid to reduce congenital anomalies.

The consultation will begin early next year and will examine the evidence regarding folic acid fortification, as well as its practicality and safety.

This follows a long campaign by doctors, health charities and scientists who believe that fortifying flour with folic acid would reduce the incidence of tube defects. neural such as spina bifida and anencephaly.

The proposal is supported by the UK Medical Directors and the Scientific Advisory Committee on Nutrition.

Announcing the consultation, Public Health Minister Steve Brine said, "We have listened carefully to experts, health charities and health professionals and have agreed that the time has come to celebrate. to explore whether flour fortification was the right approach for the UK My priority is to ensure that, if introduced, we are sure that it will be safe and beneficial for all. "

Sally Davies, chief medical professor for England, said: "Evidence shows that fortification of flour with folic acid is a practical way to reduce folic acid deficiency in pregnant women and birth defects .

"However, as with any such intervention, we need to make sure that the product is safe, which means taking into account the broader implications for the rest of the population who consume flour."

Current guidelines

At the present time, the NHS guidelines recommend to pregnant women and those who are trying to conceive to take folic acid supplements.

Women are advised to take a daily supplement of 400 micrograms when they are trying to become pregnant and continue until 12^th week of pregnancy.

If a woman is at a higher risk of having a pregnancy affected by a neural tube defect, it is advisable to take 5 mg of folic acid daily during pregnancy and continue until the end of pregnancy.^th week of pregnancy. Women with sickle cell disease, thalassemia or thalassemic trait should take 5 mg of folic acid during pregnancy.

More than 80 countries around the world are already adding wheat flour to folic acid to improve the folate status of the population and reduce the risk of congenital neural tube defects.

Some foods naturally contain folate, such as green leafy vegetables, but it is very difficult to eat enough to achieve the necessary levels of protection. Folic acid can be added to some cereals and spreads.

Many women do not take the supplement

In reality, many women do not take the supplement, especially if they do not realize that they are pregnant. The British Pregnancy Counseling Service (BPAS) has estimated that nearly half of all pregnancies in this country do not anticipate, many women will start taking folic acid too late in pregnancy to protect their baby.

Clare Murphy, director of BPAS External Affairs, said: "The UK has one of the highest rates of neural tube defects in Europe.Most fetal abnormalities can unfortunately not be avoided, but those related to folic acid deficiency can be reduced. "

She added, "The folic acid fortification is a simple public health intervention that would spare hundreds of women the sorrow of receiving the news that their baby was suffering from a serious illness."

"The evidence is clear"

The Royal College of Obstetricians and Gynecologists (RCOG) has long supported calls for fortification of flour with folic acid as a public health measure to prevent birth defects.

Dr. Alison Wright, Obstetrician Gynecologist and Obstetrician Consultant and Vice President of RCOG, said: "There are approximately 1,000 congenital malformation diagnoses in the UK, such as anencephaly and spina bifida per year, of which 85% The evidence is clear: this fortification will avoid about half of these defects.

"Fortifying flour with folic acid is a simple, safe and evidence-based measure that will reach women who are not getting enough folic acid in their diet, as well as those who do not get enough of it. may not have planned their pregnancy, this is a real opportunity to improve outcomes for families and society as a whole. "

The School of Sexual and Reproductive Health (FSRH) also welcomed the decision to consult on this idea. Its president, Dr. Asha Kasliwal, said: "The FSRH, alongside its colleagues, has long called on the government to introduce this simple but very effective measure to prevent neural tube defects in babies and improve long-term health. term of the population.

"Currently, many women of childbearing age are not getting enough folic acid in their diets, and we know that nearly half of all pregnancies are unplanned." The folic acid fortification will help ensure that pregnant women will be more likely to give birth to a healthy baby. "

Can we have too much folic acid?

The consultation will also consider if there are risks for other members of the general public.

These include determining whether an additional amount of folic acid in the diet will mask the diagnosis of conditions such as pernicious anemia, resulting in the production of functioning red blood cells. wrong.

Professor Louis Levy, head of the science of nutrition at Public Health England, said: "The vast majority of women ages 16 to 49 years have blood folate levels below the overall thresholds, which highlights a risk of pregnancy affected by an abnormality of the neural tube.

"Comprehensive evidence shows that mandatory flour fortification will greatly contribute to reducing the number of complications caused during pregnancy and to improving the folate status of the general population. positive intention shifts to action. "

Research conducted in January 2018 by scientists at the Wolfson Institute of Preventive Medicine at Queen Mary University in London showed that it was not necessary to set an upper limit for folates.

Professor Sir Nicholas Wald, Professor of Preventive Medicine at the Wolfson Institute, said: "There is no practical risk of folate toxicity in the diet, fortification with folic acid, l '. use of folic acid supplements (capsules or tablets) or all three. "