The mandatory fortification of bread or flour with folic acid is the most effective way of reducing Ireland’s high rate of birth defects, according to an official report.
The report published by the Food Safety Authority of Ireland (FSAI) highlights the need for women of childbearing age to have higher intakes of folic acid, in order to reduce the incidence of severe birth defects in Ireland.
It proposes two options for reducing neural tube defects (NTDs), the first being the mandatory fortification of bread or flour to provide about 150µg of folic acid per day in women of childbearing age. This would reduce the prevalence of NTDs by about 30 per cent.
Women of childbearing age would be advised to take an additional 400µg folic acid daily as a food supplement and the current policy of voluntary fortification of foodstuffs would continue.
Voluntary fortification of foods with folic acid would continue. Mandatory fortification of flour or bread with folic acid would require legislation.
Compared to the other option, this option has stronger evidence to support its effectiveness in further reducing the rate of NTD-affected pregnancies from the current rate.
The report by the scientific committee of the FSAI proposes a second option of voluntary fortification together with advice on supplementation. It says there is potential to improve the effectiveness of current policies by providing guidance on voluntary fortification of selected foods with folic acid by manufacturers.
Weaker evidence
However, the group says this option has weaker evidence to support its possible effectiveness than mandatory fortification.
Nonetheless, both options are being forwarded to an expert group on folic acid set up by the Minister for Health.
Dr Mary Flynn, chief specialist in public health nutrition at the FSAI, said the current low intake of folic acid by of women of childbearing age remains a significant problem in Ireland, contributing to an “unacceptably high” rate of NTDs.
“There is conclusive scientific evidence linking low levels of folate with spina bifida and related birth defects, and this a major challenge given the low levels of folic acid in the Irish diet which needs to be addressed,” said Dr Flynn.
Most women of childbearing age were not following official advice on folic acid supplementation, she admitted.
The rate of birth defects has been rising in recent years as manufacturers reduced the folic acid content of food products. Ireland used to have more widespread voluntary fortification than other European countries, and the rate of birth defects fell up to 2008.
However, it started rising again in 2009, with some researchers suggesting economic hardship caused by the recession had affected the quality of food bought by low-income families.
As few as one-quarter of women in one study by the Coombe Women’s Hospital were taking supplements while pregnant.
Neural tube defects are severe congenital disorders that have a profound impact on both mother and baby. The most common is spina bifida.
About 50 countries in the world operate a policy of mandatory fortification of foodstuff as a way of increasing the intake of folic acid.
