Women are ignoring expert advice to take folic acid supplements beforepregnancy to protect their unborn children, a study has shown.
Researchers who questioned nearly 500,000 women attending antenatal clinics in England and the Isle of Man found that fewer than one in three took folic acid prior to becoming pregnant.
These omissions were despite strong evidence showing that most cases of spina bifida and other birth defects affecting the brain, spine or spinal cord, can be prevented by boosting levels of folate – vitamin B9 – before pregnancy.
The study showed that the proportion of women who heeded the guidelines when planning a family had actually fallen, from 35% between 1999 and 2001, to 31% from 2011 to 2012.
Even among women with previous experience of a pregnancy involving a neural tube birth defect, such as spina bifida, only just over half (51%) took the supplements.
Spina bifida is a neural tube defect that occurs when the developing spinal column does not close properly, leaving nerves exposed. In most cases surgery can be carried out to repair the defect after birth, but often nerves have already been damaged leading to paralysis, incontinence and loss of skin sensation.
Among the known risk factors for spina bifida, the most important is a lack of folic acid before and at the very start of pregnancy.
The findings prompted calls for the introduction of mandatory folic acid fortification of flour in the UK, a policy already adopted in more than 70 countries, including the US and Australia.
Sir Nicholas Wald, from Queen Mary University of London, one of the study authors whose original work uncovered the protective effect of folic acid, said: “It’s a public health tragedy that, in spite of the folic acid fortification initiative in many countries, the UK has not introduced mandatory folic acid fortification. The failure to fortify flour with folic acid is like having a polio vaccine and not using it.”
The research, published in an online journal of the Public Library of Science, was conducted by a team from Queen Mary’s Wolfson Institute of Preventive Medicine between 1999 and 2012.
The research showed that more women took folic acid once they discovered they were pregnant, the proportion rising from 45% to 62% between the periods looked at in the study. But experts stress that to offer effective protection the supplements needed to be taken before pregnancy.
The study also showed strong ethnic variations, with only 17% of Afro-Caribbean women, 20% of south Asian women and 25% of east Asian women taking folic acid, compared with 35% of white Caucasian women.
Just 6% of teenagers under 20 attending the antenatal clinics had taken the supplements, while 40% of older women aged 35 to 39 followed the guidelines.
Jonathan Bestwick, co-author of the study, who is a lecturer in medical statistics at Queen Mary, said: “The current UK policy of recommending women take folic acid supplements has failed and has also led to health inequalities among ethnic minorities and younger women. The government should introduce mandatory fortification of flour with folic acid without delay.”
Joan Morris, a statistician at Queen Mary, said: “Each year in Britain there are about 1,000 pregnancies affected by spina bifida or other birth defects of the brain, spine, or spinal cord. Most of these lead to a termination of pregnancy, which is an agonising decision for couples who want a child.”
Jane Munro, from the Royal College of Midwives, said: “There is no doubt about the benefits of taking folic acid supplements for women who are planning to become pregnant. The RCM advises women to take supplements if they can.
“However, there is a need to ensure access to supplements for women who are unable to afford them, and to reach groups of women where taking these supplements is low.
“On the issue of adding folic acid to foodstuffs such as flour, we would stress the need for more discussion before such a step is taken because there will be people for whom additives will be unacceptable.”