The decision, which was made at an open board meeting in London, comes as no great surprise since the FSA's Scientific Advisory Committee on Nutrition (SACN) gave a positive recommendation at the end of last year. The agency subsequently launched its final consultation, and received around 200 responses from stakeholders. Maternal consumption of folate, or its synthetic form folic acid, is strongly associated with a reduced risk of neural tube defects (NTDs) in the early states of pregnancy. It is the clearest sign yet that the UK will follow the route trodden by the US and Canada, where mandatory fortification was introduced in 1998. The measure appears to have been a success, with NTD-affected pregnancies reported to have fallen by 26 per cent. If health ministers take the FSA's advice, it will have a big impact on food manufacturers, who will need to consider how to go about complying with the requirement. A spokesperson for the Food Standards Agency told NutraIngredients.com that it is impossible to speculate at this stage whether any assistance will be given to manufacturers. "Details like that will be unanswered until the ministers make their decision," she said. Moreover, the FSA will not actually give its advice to ministers formally until after next month's board meeting. In the meantime, discussions will take place over whether it should be bread or flour that is fortified, and appropriate labelling will be considered. Many food products such as breakfast cereals and spreads are already fortified with folic acid on a voluntary basis. The board agreed that controls on voluntary fortification should be included as part of the recommendation - as well as clear public advice on the taking of supplements so as to avoid over-consumption by some people. There have been concerns that mandatory folic acid fortification would mask vitamin B12 deficiency, particularly in the elderly. While the symptoms of B12 deficiency are alleviated by folic acid, its effects - including cognitive decline - are not. On the other hand, it is thought that around 13m people in the country do not eat enough folate. The board also sent a strong message to health departments that they need to do more work on educating the public about folic acid, and particularly at risk groups. Dame Deidre Hutton, the board's chair, said: "The FSA is committed to policy-making that benefits people's health. … The board recognises that this move, as part of a package of measures, will help prevent birth defects in pregnancy and have wider health benefits for the rest of the population. The board was also reassured by the significant science that the benefits outweigh potential risks." At the moment, women who are planning to get pregnant are advised to take a 400 microgram supplement before conception and until the 12th week of pregnancy. It is thought that many women do not follow or are unaware of this advice however. Between 700 and 900 pregnancies in the UK are affected by NTDs each year, not including miscarriages.