UK Government urged to put vitamin additive in flour to stop needless birth defects

"Failing to fortify flour with folic acid to prevent neural tube defects is like having a polio vaccine and not using it," researchers said as risks of excessive intake now debunked

Alex Matthews-King
Health Correspondent
Wednesday 31 January 2018 01:27
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Folic acid deficiency can lead to birth defects including spina bifida, where the baby’s spinal cord bulges out into its back
Folic acid deficiency can lead to birth defects including spina bifida, where the baby’s spinal cord bulges out into its back

Three thousand children have been born with birth defects that could have been prevented if the UK adopted scientifically backed proposals to add essential vitamin folic acid to flour.

Researchers are calling on the Government to rethink its 1mg-per-day upper recommended limit for folic acid intake, saying it is based on “flawed” analysis and deficiency linked defects are an “avoidable tragedy” causing two terminated pregnancies a day.

The upper threshold is based on data more than 50 years old, which the scientists say incorrectly concluded that excessive folic acid intake could cause neurological issues.

But a re-examination of this data, published today in the journal Public Health Reviews, found no such link with folic acid, a finding that independent paediatric specialists said would be a “game changer”.

The researchers from Queen Mary University of London argue the UK should abandon the upper limit and follow the US and the other 80 countries that have fortified flour with folic acid since 1998, when deficiency risks first became clear.

The UK already fortifies flour with iron, calcium and other essential B vitamins, and Professor Nicholas Wald, from the Wolfson Institute of Preventive Medicine, said: “Failing to fortify flour with folic acid to prevent neural tube defects is like having a polio vaccine and not using it.

“Every day in the UK, on average two women have a termination of pregnancy because of a neural tube defect and every week two women give birth to an affected child.”

The link with neurological problems resurfaced last year when US researchers claimed that excessive folate levels could increase the risk of autism.

But this was based on research that had yet to go through wider peer review and was condemned as “irresponsible” and “alarmist” by scientists.

Folic acid can be found in foods like leafy green vegetables and brown rice, but not in sufficient quantities and pregnant women are advised to take supplements in the first three months of pregnancy.

This is the period when the foetus’s spinal cord is developing and folic acid, also known as vitamin B9, is essential to this process where deficiencies can lead to serious problems in the spine and brain.

These conditions, dubbed neural tube defects, include spina bifida, which can go unnoticed but at its most serious can cause the spinal cord to bulge out into the baby’s back because protective vertebrae don’t form.

It can also cause anencephaly, where a major portion of the brain and skull fails to develop.

While neural tube defects also have a genetic component, the increased risk from folic acid deficiency was first exposed in 1991, prompting countries, including Canada, the US and many African and Caribbean nations, to begin fortifying common foods.

There is no evidence of harm from excessive consumption in these countries and the incidence of neural tube defects halved from its pre-fortification rates.

The paper notes that there have been more than five million preventable neural tube defect pregnancies since 1991 worldwide, and the number of cases that could be prevented with folic acid “far exceeds” other preventable birth defects, for example those caused by thalidomide.

It concludes: “There is no scientific basis for setting an upper level of intake for folate.”

Co-author Professor Joan Morris said: “From 1998, when the protective effect of folic acid was first shown, to 2017, an estimated 3,000 neural tube defects could have been prevented if the UK had adopted the same level of folic acid fortification as in the United States.

“It’s a completely avoidable tragedy.”

This was backed by medical experts who were unaffiliated with the study, saying the medical community is widely in support of fortification.

Professor Neena Modi, president of the Royal College of Paediatrics and Child Health, said: “This new research is a game changer for fortification in allaying concerns about exceeding an upper limit of 1mg/day.

“In the early stages of pregnancy when neural tube defects arise, many women do not know they are pregnant, others may be unaware of the importance of taking folic acid, or may forget, so fortification of flour, which is harmless if consumed by children and adults, is a logical answer to a problem which can have catastrophic consequences.”

The Department of Health and Social Care said it is carefully considering an evidence review from the UK’s Scientific Advisory Committee on Nutrition, which is also calling for the upper threshold to be dropped.

A spokesperson added: “We want mums-to-be to have healthy pregnancies, and NHS guidance is that women planning a pregnancy should take a daily supplement of 400mg of folic acid before conception and until the 12th week of pregnancy.

“We also recommend eating more folate-rich foods to reduce the risk of neural tube defects.”

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