Putting folic acid in flour in Britain will save 400 babies each year, scientists say after move was introduced in 80 other countries
- If woman lacks folic acid when she conceives it increases risk of brain deformity
- The deficiency also hugely raises the risk of a baby being born with spina bifida
- Leading experts have declared that Ministers have a moral duty to act
Hundreds of babies are needlessly dying every year or left with lifelong disabilities because successive governments have failed to make food firms add folic acid to flour, say top scientists.
They argue that the measure would be safe and effective and has been successfully introduced in 80 other countries while the UK has dragged its heels.
Experts have known for decades that if a woman lacks Vitamin B9 – also known as folic acid – when she conceives, it greatly increases the risk of a brain deformity that is almost always fatal.
The deficiency also hugely raises the risk of a baby being born with spina bifida. Yet for almost 30 years, governments have dithered over forcing food producers to add folic acid to flour.
By the time a pregnant women discovers she is expecting, ‘it is already too late’ for supplements, said Prof Wald
Now, three leading experts have declared that Ministers have a moral duty to act. The move comes as Boris Johnson’s new Government considers the issue after a 12-week public consultation.
Professor Sir Colin Blakemore, former chief executive of the Medical Research Council, said: ‘I hope this time the Government introduces folic acid fortification, which would save the lives of hundreds of babies a year. It would be shocking if it did not.’
Professor Sir Nicholas Wald, whose research first proved folic acid deficiency increases the risk of ‘neural tube defects’ (NTDs), said: ‘Over 80 countries have introduced mandatory folic acid fortification of flour, with no hint of harmful effects. It is safe, effective, and wouldn’t cost the Government anything. If it was deferred again, it would be a tragic missed opportunity.’
Government advice to women thinking of conceiving has been to take folic acid supplements. But only a third do so - adding the supplement to flour would increase the intake
Since his 1991 research, Government advice to women thinking of conceiving has been to take folic acid supplements. But only a third do so.
A key factor is that the neural tube – which goes on to form the brain and spine – develops very early in pregnancy. If a woman is B9 deficient at conception, her baby is already at higher risk of NTDs.
WHAT ARE NEURAL TUBE DEFECTS?
Neural tube defects are deformities of a person's brain, spine or spinal cord which occur in the very early stages of pregnancy.
They happen when the foetus does not develop properly, usually during the first four weeks after conception.
The most common forms of NTD are conditions called anencephaly, spina bifida and encephalocele.
Anencephaly is when a foetus does not develop its entire brain or skull – almost all babies which are born with it die shortly after.
Spina bifida, a deformity of the spine, is less often fatal and many children survive well into adulthood, but it can cause severe disability.
Encephalocele happens when part of a baby's brain and membranes protrude out of the head through a hole in the skull. This may be treated with surgery but will likely cause long-term brain problems.
Women are advised to take 400 micograms of folic acid per day during and before pregnancy until at least the 12th week after conception, because it has been proven to reduce the risk of neural tube defects.
By the time she discovers she is expecting, ‘it is already too late’ for supplements, said Prof Wald.
More than 1,000 pregnancies in Britain are blighted by NTDs every year, with 800 ending in the death of the baby before or soon after birth. Of the 200 or so who survive birth, ‘some die very young; others have severe handicap and typically die in their 40s’, said Prof Blakemore.
Medical statistician Professor Joan Morris, of St George’s, University of London, said ‘political will’ was needed ‘to prevent one of the most serious birth defects’.
The trio want fortification resulting in about 0.4mg of folic acid consumption a day – the level used in Chile, where NTDs have plummeted by nearly 60 per cent. In the UK, that would save more than 400 babies’ lives a year and prevent another 100 suffering spina bifida.
Writing in the Archives of Disease in Childhood, the experts say: ‘The moral arguments for the public health intervention of fortification are undeniable.’
A Department of Health and Social Care spokesman said: ‘We consulted the public on fortifying flour with folic acid. We are reviewing all responses and recommendations on how to proceed will be put to Ministers in the New Year.’
Alex Waugh, director of the Flour Millers’ Association, said: ‘If the Government decides this is the right policy, we will find the best method for doing it – but there are potential complications.’
WHAT IS SPINA BIFIDA?
Spina bifida is a relatively common birth defect, affecting about 1,500 to 2,000 babies born in the US each year and around 700 in the UK annually.
Babies born with spina bifida have improperly formed spines and spinal cords.
During development these structures - along with the brain - all arise out of something called a neural tube, a precursor the entire central nervous system as well as the protective tissues that form around them.
Typically, this tube forms and closes by the 28th week of pregnancy.
But in babies with spina bifida, it doesn't close properly, for reasons that are not entirely clear yet to scientists.
Instead, these babies are left with a gap in the vertebrae, through which part of the spinal cord may slip, depending the severity.
People with the mildest form of spina bifida - the occulta form - may not even know they have it.
The gap between their vertebrae is so small that the spinal cord stays in place and they are unlikely to experience any kind of neurological or motor symptoms.
In the next more severe form of the condition, called meningocele, the the protective fluid and membranes around the spinal cord are pulled through a gap into a fluid filled sack on the exterior of the baby's back.
There's no actual nervous tissue out of place, so there may be complications, but they're less likely to be life altering.
But in open spina bifida, or myelomeningocele, there are larger or multiple openings along the spine.
Both the membranes and spinal nerves and tissues they're meant to protect are pulled outside the baby at birth.
The symptoms vary wildly based on where and how severe these openings are.
Some children may develop little more than skin problems, while other with severe forms may be unable to walk or move properly, or develop infections like meningitis that can leave them with permanent brain damage.
Making sure women get plenty of folic acid in pregnancy can help ensure the spinal cord develops properly.
After birth, surgery to repair these openings may be performed and, in more recent years, some surgeons have begun repairing spina bifida in the womb.
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