Babies are being put at unnecessary risk of death and disability because the Governments recommended dose of folic acid for pregnant women is far too low, a leading scientist is warning.
The current daily intake needs to be 10 times higher than the 0.4mg currently advised in a change that would save hundreds of UK lives a year, according to Professor Nicholas Wald, an expert in preventative medicine.
Taking 4 milligrams of folic acid supplements a day would have a significant effect in preventing serious birth defects and associated stillbirths, neonatal deaths, miscarriages, elective terminations of pregnancies and the physical disability from spina bifida, Professor Wald said.
This amount of folic acid, taken from before conception to the 12th week of pregnancy, reduces by 83 per cent the risk of the foetus developing neural tube birth defects of the brain, spine, or spinal cord that can also cause anencephaly, in which a baby is born without parts of the brain and skull and encephalocele, another very serious skull defect; Professor Wald says in a new paper in The Journal of Medical Screening.
About 1,000 foetuses a year in the UK and 300,000 worldwide develop neural defects, with most women in Britain choosing to have a therapeutic abortion when they are identified through anti-natal screening. The defects are usually caused by a deficiency in folate, the natural form of vitamin B9.
Professor Wald said it was unlikely any women would already have high enough levels of folic acid and not need supplements since the blood levels of folate are really relatively low by any standards this is a vitamin deficiency disorder that is endemic throughout the world, including rich countries.
Dark green leafy vegetables such as spinach, romaine lettuce and broccoli, whole grains and beans are among the foods that are rich in folic acid. But the academic says eating them wont be enough to compensate.
To get the levels that will provide the maximal possible protection is extremely difficult to do just by changing diet and changing diet is pretty difficult, Professor Wald said.
At the moment, the biggest dose folic acid pill that is generally available is 0.8mg, which can be found in health food stores so taking five of these a day would be ideal, he said.
But even two or three a day would still be extremely worthwhile and provide most of the benefit, the expert advises.
A bit less will accomplish most of the protective effect, Professor Wald said. You get most from the first 0.8mgs. So you should certainly use at least one 0.8mg pill and if you want added effect you could take two, three or four additional ones.
He also recommends that women start taking the supplement before they know theyre pregnant.
If you wait till you know you are pregnant before you start taking folic acid there is probably no benefit because the neural tube develops in the first few weeks of pregnancy, he said.
Professor Wald led the landmark Medical Research Council Vitamin Study, that in 1991 definitively established folate deficiency as a cause of neural tube defects.
He dismisses as outdated, concerns in some circles including among some government advisers that larger doses of folic acid might mask signs of a vitamin B12 deficiency during pregnancy, which can lead to problems such as premature births.
The concerns about folic acid masking stem from the fact that folate or Vitamin B9 deficiency and vitamin B12 deficiency both cause macrocytic anaemia, a blood disorder that happens when your bone marrow produces abnormally large red blood cells.
Folic acid can, in large enough doses, correct the anaemia of vitamin B12 deficiency without mending the neurological damage that it can also cause.
This effect of folic acid has been referred to as masking vitamin B12 deficiency. But Professor Wald says the term is misleading because there is no evidence that a folic acid could lead to delayed or missed diagnosis.
He says that anaemia is not needed to diagnose the problem. Separate tests for measuring folic acid levels in blood and vitamin B12 have been available for decades.
However, the Government does not share that view.
A government consultation on the proposed fortification, in September 2021, noted concerns that consistent high intakes of folic acid from supplements could potentially increase the risk of masking (hiding or disguising) vitamin B12 deficiency in people with a condition known as pernicious anaemia.
And it indicated there were concerns about a daily folic intake exceeding 1mg just a quarter of Professor Walds recommendation.
Professor Wald also says there is no evidence to support concerns that a higher dose of folic acid could be neurotoxic.
Experts not involved in Professor Walds study are backing his recommendation.
I would strongly advise all women who might get pregnant in the near future to take 4mg/day of regular Folic acid 4mg/day, said Dr Miles Mack, chair of the Academy of Medical Royal Colleges and Faculties in Scotland and a GP in the Highlands town of Dingwall.
Dr Jonathan Sher, a senior fellow of the Queens Nursing Institute Scotland, said 4mg a day was safe and effective in preventing approximately 80 per cent of neural tube defects.
Lord Rooker, a former chairman of the Food Standards Agency and Minister of State at the Ministry of Agriculture, Fisheries and Food under Tony Blair, said: Four mg per day appears sensible.
In the longer term Professor Wald and others want to see folic acid added to flour and grains in quantities that would mean most pregnant women would automatically be well protected against neural tube defects without having to resort to supplements.
The Government is proposing to fortify non-wholemeal wheat flour or typical white bread with folic acid. But it would be in amounts which Professor Wald says are woefully inadequate, because the Government regards 1mg a day to be its upper limit because of concerns about masking, with flour concentrations to be determined accordingly.
The UK governments proposed folic acid fortification policy is seriously inadequate, not evidence-based and certain to fall well short of full effectiveness, Professor Wald and Professor Joan Morris, of Queen Mary College of London, argue in an opinion piece published yesterday in the British Medical Journal publication Archives of Disease in Childhood.
The exclusion of potential mothers with a diet that is not covered by the fortification policy is socially divisive and should not be acceptable. All flour and grains, such as rice, should be fortified at a sufficient level to achieve fully effective fortification across the whole population. It is not too late to do the right thing, they said, pointing out that the proposed fortification would only reduce the risk of neural tube defects by 8 to 12 per cent compared to more than 80 per cent at higher levels.
Of the Governments proposals to introduce folic acid fortification in white bread, guided by the notion of a 1mg ceiling, Dr Sher said: I see no wisdom in the UK government choosing to do too little for too few women and children when doing it properly is easily achieved.
Dr Mack said: I am extremely glad that the issue of folic acid fortification is finally being looked at but I am extremely concerned that the opportunity to maximise the benefit to the entire population will be missed if the level of fortification is set too low. The next generation deserve better from policy makers.
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Why 4mg of folic acid will dramatically reduce the risk of birth defects during pregnancy - iNews
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