Government Consultation on Adding Folic Acid to Flour

Last week the government began a consultation on whether to introduce mandatory fortification of flour with folic acid to help reduce neural tube defects in foetuses.

Pregnant women are advised to take folic acid for at least a month before conception and up to the twelfth week of pregnancy. However, as many pregnancies are unplanned (or not identified until a number of weeks after conception) many women miss the opportunity to follow this advice. In addition, the cost of buying supplements means that women from the poorest areas of the UK are the least likely to take folic acid supplements (a fact noted by Public Health Minister Seema Kennedy who argues 'it is right that we do all we can to protect the most vulnerable in society').

Neural tube defects (such as spina bifida or anencephaly) affect about 1,000 pregnancies per year in the UK. Over 40% of cases are fatal and most babies who survive will need continuing care.

Adding folic acid to flour is not a new idea; it was first recommended by the Government's Scientific Advisory Committee on Nutrition ("SACN") in 2006 who noted that, in addition to increasing the folate intake of pregnant women, it would be of 'net benefit to the UK population'. Although over a decade has passed without any action, adding supplements to flour is not a particularly drastic step; currently UK milled wheat flour already has thiamine, niacin, iron and calcium added to it during production.

Over sixty countries around the world add folic acid to flour, and campaigners for the introduction have highlighted the success the policy has had in these countries. Following its introduction in Canada in the late 1990s neural tube defects halved; in Australia they fell by 14%.

Concerns have been raised, however, about the impact the introduction could have on the general population. It has been suggested that a consistently high intake of folic acid could cover up the symptoms of Vitamin B12 deficiency (which can be a particular concern for the elderly). Equally, folic acid supplements can interact with some medicine and so certain individuals may be advised to monitor their intake. The Government has confirmed that 'due consideration' will be given to these concerns as part of the consultation and any implementation.

The consultation runs for twelve weeks and should be of interest to any organisations or healthcare professionals involved in the care of pregnant women, children, and adults with neural tube defects. Insurers may wish to draw the consultation to the attention of their Insureds, so they can ensure that any concerns or queries they have are raised during the consultation period.

If the outcome of the consultation is in favour of mandatory fortification, Insureds will need to be aware of the introduction date and the potential impact on the care they provide. Advice given to women during (and before) pregnancy about folic acid will need to be updated, as will advice to patients taking medicine that interacts with folic acid. Finally, medical practitioners should be ready to discuss the introduction with any patients who may be concerned about it.