Folic acid should be added to rice as well as flour to prevent hundreds of cases of ‘tragic’ birth defects every year, experts have said today.
Ministers have already announced the nutrient will be baked into white and brown bread.
Officials estimate that, annually, it will stop 200 babies being born with neural tube defects, which are usually caused by a folic acid deficiency and can lead to life-long disability.
But leading researchers have now criticised the Government’s ‘half-hearted’ policy.
Up to 800 cases could be avoided every year if the nutrient was also added to rice and doses were 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 1,000 babies in the UK are born with each year — which are usually caused by a folic acid deficiency
Folic acid, a synthetic version of the vitamin folate (B9), is found naturally in broccoli, peas and brown rice.
The NHS advises 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 from diet alone. To get the recommended amount each day, a woman would need to eat at least four servings of foods high in folic acid, such broccoli, kale and spinach or eight portions of foods with medium levels, such as kidney beans, courgette or oranges.
Folic acid: Everything you need to know
The nutrient, a synthetic version of the vitamin folate (B9), helps the body make healthy red blood cells.
It is present in green vegetables such as broccoli and Brussels sprouts but pregnant women need a significantly higher dose.
A lack is associated with neural tube defects, including spina bifida – when a baby’s spine does not develop properly in the womb. It can lead to paralysis.
Others, like anencephaly — when a baby is born without parts of the brain and skull, can be fatal.
Around 80 countries, including the US, Canada and Australia, already add folic acid to flour.
However, opponents say there is no guarantee that pregnant women will eat enough bread to get a sufficient dose.
They have also called for more work on possible side-effects.
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 life-long disabilities, such as spina bifida, when a baby’s spine does not develop properly in the womb. It can lead to paralysis.
Others, like anencephaly — when a baby is born without parts of the brain and skull — can be fatal.
Such defects, spotted through routine screening, occur within the first month of pregnancy, when the neural tube is completely formed.
Eight in 10 women choose to have an abortion after it is detected.
But experts say the current NHS advice doesn’t work, as half of pregnancies in Britain are not planned and only one in three pregnant women take the supplement.
British medical bosses first ruled that it should be mandatory for flour to be fortified with folic acid in 2006.
But it wasn’t until September 2021 that the Government revealed plans to add folic acid to non-wholemeal wheat flour in a bid to reduce cases of neural tube defects.
The policy has been rolled out in around 80 other countries, including the US, Australia and New Zealand.
Those nations were prompted by a landmark 1991 study, which showed that regularly consuming sufficient levels of folic acid before pregnancy reduced cases of neural tube defects by 80 per cent.
Ministers are thought to have stalled because they feared being accused of ‘mass medication’ and acting like a ‘nanny state’.
They are still considering what level to mandate but have proposed 0.25mg of folic acid per 100g of non-wholemeal wheat flour.
However, experts today warned the approach is ‘too narrow’.
They said the plans would only cut neural tube defect cases by 20 per cent per year — meaning approximately 200 fewer babies are born with the condition.
But increasing fortification to 1mg per 100g of flour and rice would prevent 80 per cent of cases, reducing the number of newborns with the condition by 800 annually.
Professor Sir Nicholas Wald, an expert in preventive medicine at the University College London and author of the 1991 study into folic acid, said the Government’s mandatory fortification decision is ‘welcome’ but isn’t at the right level to be ‘fully effective’.
He said: ‘The Government proposals would see 600 avoidable cases that are not prevented.
‘That should be rectified and one should go rapidly to the preferred fully effective fortification policy.’
Professor Sir Nicholas Wald (left), an expert in preventive medicine at the University College London and author of the 1991 study into folic acid, said the Government’s mandatory fortification decision is ‘welcome’ but isn’t at the right level to be ‘fully effective’. Professor Dame Lesley Regan (right), a former president of the Royal College of Obstetricians and Gynaecologists, warned the UK was ‘lagging behind’ and that it ‘does not make sense’ to get folic acid fortification ‘wrong’ or do it ‘half-heartedly’
He warned couples are terminating pregnancies that they wanted which is a ‘frightful tragedy that could be avoided in so many cases’.
Others have children who face a ‘lifetime of hospitalisations’, can be paralysed from the waist down and suffer incontinence.
Professor Dame Lesley Regan, a gynaecologist at Imperial College’s St Mary’s Hospital Campus, said there are scientific, medical, ethical and economic reasons for administering the ‘correct dose’ of folic acid for ‘maximum protection’.
The Government’s women’s health tsar said: ‘I don’t think we can dismiss the emotional and psychological trauma of this.’
Terminations due to neural tube defects — detected at a scan 20 to 22 weeks into pregnancy — require several days in hospital.
And babies born with neural tube defects costs the NHS £30m over their lifetime, which Dame Lesley said is ‘not sustainable’.
Dame Lesley, who is also a former president of the Royal College of Obstetricians and Gynaecologists, warned the UK was ‘lagging behind’ and that it ‘does not make sense’ to get folic acid fortification ‘wrong’ or do it ‘half-heartedly’.
Professor Neena Modi, an expert in neonatal medicine at Imperial College London, said each pregnancy affected by neural tube defects is a ‘tragedy’.
Encouraging women to take folic acid supplements along with the proposed ‘low level’ of fortification will miss out ‘large swathes’ of the population, she said.
Women who avoid gluten or whose main source of carbohydrate is rice will be disadvantaged, Sir Nicholas warned.
And mothers from ethnic minority backgrounds, ‘who predominantly eat rice, not flour’, are already up to two-and-a-half times more at risk of their baby having neural tube defects, Professor Modi said.
‘We have a major issue with health disparities and the current proposals will widen these,’ Professor Modi said.
The group said the Government has proposed a low level of folic acid based on advice from Scientific Advisory Committee on Nutrition and the Committee on Toxicity.
Both committees have expressed concern over a ‘theoretical risk’ that a high dose of folic acid could mask some symptoms of a B12 deficiency and exacerbate neurological damage among those who are deficient in that vitamin.
Professor Modi said these concerns are ‘historic and ill-founded’.
She said: ‘To base policy on a theoretical risk against a quantifiable risk to a baby does not seem to be justified.
‘We feel 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 B12 deficiency diagnoses are not ‘taken seriously’.
The deficiency is ‘not common’, patients usually present early with symptoms and it is easily detected through a blood test, he added.
Under current rules, white and brown flours are already fortified with calcium, iron, thiamine (Vitamin B1) and niacin (Vitamin B3).
Roughly 500g of flour is needed to make one loaf of bread, which is equal in size to shop-bought offerings.
A Department of Health and Social Care spokesperson said: ‘We are currently analysing the responses to the consultation on amending the Bread and Flour Regulations and will provide an update in due course.
‘Once published, our response will confirm the agreed level of folic acid to be added to non-wholemeal wheat flour.
‘The established advice to take a folic acid supplement up to the 12th week of pregnancy, to help prevent neural tube defects, will remain in place when folic acid is added to flour.’