In order to reduce the rates of serious birth defects, all flour sold in the UK will now be fortified with folic acid. The government announcement, reported today by the Guardian, represents a hard-won victory for the many medical organizations and children’s health advocacy groups who have been lobbying for such a policy for decades.

Folic acid or folate, also known as vitamin B9, is an essential human micronutrient involved in DNA and RNA synthesis and the metabolism of amino acids. In pregnant women, a lack of folate can interfere with the formation of the fetus’ neural tube – the tissue structure that develops into the brain and spinal cord, thus leading to several lethal or permanently disabling disorders such as spina bifida and anencephaly.

It has been shown that folate supplementation during pregnancy can reduce the risk of neural tube defects (NTDs) by up to 70 percent, but much of the critical neural tube development phase occurs very early in gestation, meaning that many women may not even know they are pregnant until after the damage is done.  

To ensure that expectant women are receiving adequate folate levels from the outset, the US, Mexico, Canada, and dozens of other nations have instituted mandatory flour fortification laws. Large-scale studies show that the incidence of NTDs dropped by 23 percent in the US and by more than 14 percent in Australia after their fortification programs began in 1998 and 2009, respectively.

“I am delighted to hear the news reported in the Guardian that flour will be fortified with folic acid in the UK, to prevent the birth defects spina bifida and anencephaly. If this is officially confirmed, the UK would be taking an important step in preventive medicine, and helping to avoid disability or termination of pregnancy,” Nicholas Wald, a professor of Environmental and Preventative Medicine at Queen Mary University of London, told the Science Media Centre.

“There will undoubtedly now be discussion over the level of fortification, which should be high enough to prevent an estimated half of cases of spina bifida and anencephaly. Fortification of flour with folic acid provides a safety net; it does not mean that women no longer need to take a folic acid supplement and this should be 5mg a day, to obtain the full level of protection.”

Folate occurs naturally in many dark green leafy vegetables, legumes, and nuts, as well as certain types of meat – liver and kidney in particular – and eggs. Yeast extract is one of the best natural sources. Physicians recommend that women should begin eating high-folate foods and taking supplements when they start trying to become pregnant and up until the 12th week. These regimens make NTDs unlikely for children born to women with financial means and those who planned their pregnancies, yet these birth defects remain a significant concern for women with unplanned pregnancies and those unable to purchase fresh foods and daily vitamins. (Among marginalized indigenous Australian women, the nation's fortification policy has led to a 74 percent reduction in NTD rates.)

According to the Guardian, Britain is estimated to have the highest rates of NTDs among all European nations. About two UK women have abortions due to a fetal NTD per day and two babies with NTDs are born per week.

“Three-quarters of 16- to 49-year-old women have folic acid levels below the new World Health Organization recommendation for women entering pregnancy," Dr Alison Tedstone, the chief nutritionist at Public Health England, told the newspaper. "Fortifying flour with folic acid is an effective and safe measure to reduce the number of pregnancies affected by neural tube defects.”