Folic acid must be added to both rice and flour to prevent hundreds of cases of “tragic” birth defects every year, experts said today.
Ministers have already announced that the nutrient will be baked into white and brown bread.
Officials estimate that 200 babies will be born each year with neural tube defects, which are usually caused by folic acid deficiency and can lead to lifelong disability.
But leading researchers are now criticizing the government’s “half-hearted” policy.
Up to 800 cases could be avoided each year if the nutrient were also added to rice and doses quadrupled, they claimed.
The government unveiled plans 18 months ago to add the nutrient to flour to prevent neural tube defects – a group of conditions affecting 1,000 babies in the UK every year – which are usually caused by a lack of folic acid
Folic acid, a synthetic version of the vitamin folate (B9), occurs naturally in broccoli, peas and brown rice.
The NHS recommends that women take 400 micrograms of folic acid daily while trying to conceive and for the first three months of pregnancy.
But it can be difficult to get out of a diet alone. To get the recommended amount per day, a woman should eat at least four servings of foods high in folic acid, such as broccoli, kale, and spinach, or eight servings of medium-content foods, such as kidney beans, zucchini, or oranges.
A deficiency before or during pregnancy can lead to defects in a growing baby’s neural tube, which becomes their brain, spinal cord, and central nervous system.
Defects can lead to lifelong disabilities, such as spina bifida, when a baby’s spine doesn’t develop properly in the womb. It can lead to paralysis.
Others, such as anencephaly — when a baby is born without parts of the brain and skull — can be fatal.
Such defects, spotted by routine screening, occur within the first month of pregnancy, when the neural tube is fully formed.
Eight out of ten women choose to have an abortion after it is discovered.
But experts say the current NHS advice is not working as half of Britain’s pregnancies are unplanned and only one in three pregnant women take the supplement.
British medical bosses first decided in 2006 that it should be mandatory to enrich flour with folic acid.
But it wasn’t until September 2021 that the government announced plans to add folic acid to non-whole wheat flour to reduce the number of cases of neural tube defects.
The policy has been rolled out in about 80 other countries, including the US, Australia and New Zealand.
Those countries were prompted by a groundbreaking 1991 study that found that regularly consuming enough folic acid before pregnancy reduced the number of cases of neural tube defects by 80 percent.
Ministers are thought to have quit because they feared being accused of ‘mass medication’ and behaving like a ‘nanny state’.
They are still considering what level to make mandatory, but have suggested 0.25mg of folic acid per 100g of non-whole wheat flour.
However, experts warned today that the approach is “too narrow”.
They said the plans would only reduce the number of cases of neural tube defects by 20 percent a year, meaning about 200 fewer babies being born with the condition.
But increasing the fortification to 1mg per 100g of flour and rice would prevent 80 percent of cases, reducing the number of newborns with the condition by 800 annually.
Professor Sir Nicholas Wald, an expert in preventive medicine at University College London and author of the 1991 study on folic acid, said the government’s mandatory fortification decision is ‘welcome’ but not at the right level to be ‘fully effective’ to be.
He said: ‘The government’s proposals would create 600 preventable cases that are not prevented.
‘That must be rectified and the desired fully effective settlement policy must be adopted quickly.’
Professor Sir Nicholas Wald (left), an expert in preventive medicine at University College London and author of the 1991 study on folic acid, said the government’s mandatory fortification decision is ‘welcome’ but is not at the right level to ‘ to be complete’. effective’. Professor Dame Lesley Regan (right), a former president of the Royal College of Obstetricians and Gynecologists, warned that the UK was ‘lagging behind’ and that it ‘doesn’t make sense’ to get folic acid fortification ‘wrong’ or doing it ‘halfway’ -heartily’
He warned couples ending pregnancies they wanted, which is a “terrifying tragedy that could have been avoided in so many cases.”
Others have children who are “in hospital for a lifetime,” who can become paralyzed from the waist down and suffer from incontinence.
Professor Dame Lesley Regan, a gynecologist at Imperial College St Mary’s Hospital Campus, said there are scientific, medical, ethical and economic reasons to administer the ‘right dose’ of folic acid for ‘maximum protection’.
The government’s women’s health czar said, “I don’t think we can ignore the emotional and psychological trauma of this.”
Terminations due to neural tube defects — detected on a scan 20 to 22 weeks into pregnancy — require several days in the hospital.
And babies born with neural tube defects cost the NHS £30 million over their lifetime, which Dame Lesley says is ‘unsustainable’.
Dame Lesley, who is also a former president of the Royal College of Obstetricians and Gynecologists, warned that the UK was ‘lagging behind’ and that it ‘makes no sense’ to get folic acid fortification ‘wrong’ or to do it ‘half-heartedly’.
Professor Neena Modi, an expert in neonatal medicine at Imperial College London, said any pregnancy with neural tube defects is a ‘tragedy’.
By encouraging women to take folic acid supplements, along with the proposed “low level” of fortification, “large segments” of the population are missing out, she said.
Women who avoid gluten or whose main source of carbohydrates is rice will be at a disadvantage, Sir Nicholas warned.
And mothers from ethnic minorities, “who eat mostly rice, not flour,” are already up to two and a half times more likely to have their baby develop neural tube defects, Professor Modi said.
“We have a big problem with health inequalities and the current proposals will exacerbate them,” said Professor Modi.
The group said the government has proposed low levels of folic acid based on advice from the Scientific Advisory Committee on Nutrition and the Committee on Toxicity.
Both committees have expressed concern about a “theoretical risk” that high doses of folic acid may mask some symptoms of a B12 deficiency and exacerbate neurological damage in those who are deficient in that vitamin.
Professor Modi said these concerns are “historic and unfounded”.
She said: ‘Basing policy on a theoretical risk versus a quantifiable risk to a baby does not seem justified.
“We think it would be wiser to move to a fully effective fortification strategy.”
Professor Peter Rothwell, a neurologist at the University of Oxford, said concerns about missed diagnoses of B12 deficiency are not ‘taken seriously’.
The deficiency is “not common,” patients usually show symptoms early and it is easily detected through a blood test, he added.
According to current rules, white and brown flour are already enriched with calcium, iron, thiamine (vitamin B1) and niacin (vitamin B3).
It takes about 500g of flour to make one loaf of bread, which is the same size as what you buy in the store.
