The folic acid message must move beyond the taboo of ‘trying for a baby’

By Annie Harrison-Dunn contact

- Last updated on GMT

Nothing can compete with supplements when it comes to upping folic acid in pregnancy, says Irish public health body
Nothing can compete with supplements when it comes to upping folic acid in pregnancy, says Irish public health body
We must tackle the taboo around folic acid supplementation if we are to tackle the rising rate of neural tube defects in Ireland, says public health body.

Research​ in Ireland published earlier this year showed less than one in four women took folic acid before they conceived and one in ten wrongly believed they got enough folic acid from food alone.

Safefood, the Irish public body responsible for raising consumer awareness on food safety and healthy eating, has launched a campaign on the issue this month in response to an increase in neural tube defects (NTDs) in Ireland for the first time since the 1990s.  

According to a study published in the Journal of Public Health​ in 2014, the incidence of NTDs in the Republic of Ireland increased from 0.92 out of 1000 births in 2009 to 1.17 in 1000 by 2011, with one theory for this being that the Irish population was genetically predisposed due to the way it absorbed folic acid. 

Speaking with NutraIngredients, Dr Marian Faughnan, Safefood's chief nutrition specialist, said a key challenge in addressing this was that many women assumed they should only take folic acid supplements if they were planning to get pregnant.

Neural tube defects are caused by the incomplete development of the brain, spinal cord and/or their protective coverings and occur when the foetus’ spine fails to close properly. Folic acid (vitamin B9) plays a role in cell growth and therefore this process.

The condition forms in the first 28 days of pregnancy, before many women know they are pregnant. It is usually diagnosed at the 20-week scan and often results in late terminations, according to the charity Shine. Abortion in the Republic of Ireland is illegal unless it is a medical intervention to save the life of the mother.

Shine says each day in the UK an average of at least two babies conceived will develop (NTDs) such as spina bifida and the fatal condition anencephaly.

Worldwide, at least 300,000 newborns are affected by an NTD every year.

We need to talk

Much of the campaign’s material – including ‘Facts about Folic’ videos – sought to counter the taboo that if a woman took folic acid she wanted to get pregnant.

“This is a debate we need to have among women,”​ she said.

The topic needed to become a matter of women’s health, not just women looking to start a family. She called this an “insurance policy for the future”​.

Another option could be to encourage practitioners to routinely recommend folic acid supplements to young women. The Irish school curriculum already included information about the importance of the vitamin in foetal development.

1 supplement vs 1.2 kg of broccoli

Women need 200 micrograms (mcg) of folic acid per day ordinarily, which can be achieved easily with a healthy diet. For pregnant women though this jumps to 600 mcg, which would take something like 1.2 kg of broccoli a day to achieve.

Faughnan said this explicit message of supplementation marked a departure from the usual line of UK and Irish public health bodies, which tended to advocate a healthy balanced diet with supplementation only in some cases of deficiency like anaemia.

She said even fortified foods could “never be an alternative to supplements”​ since this could only ever bring the baseline up by a maximum of 25%.

Mandatory folic acid fortification of wheat flour has been a topic of heated debate in the UK since the publication of a Medical Research Council trial in 1991, which suggested folic acid (vitamin B9) may help reduce the risk of neural tube defects by up to 72%.

At the end of June this year the UK government put forward a bill proposing folic acid be added to the list​ of mandatory micronutrients used to fortify wheat flour under the Bread and Flour Regulations 1998 - movement seen after decades of debate.

Last year the European Food Safety Authority (EFSA) approved a health claim​ for women of child-bearing age for supplements which provided at least 400 mcg of folic acid per daily portion, stating: “Low maternal folate status is a risk factor in the development of neural tube defects in the developing foetus.”

The campaigners and trade groups behind the claim said the approval would transform communication on the issue. 

Preparing for the unexpected  

Faughnan said the country’s 1990s campaign had focused on the idea of taking the supplements 12 weeks before conceptions. “That’s fine if you’re organised. But the reality is 50% of all pregnancies are unplanned.”

This fact needed to be taken into account when forming public health policy. The authority was urging all sexually active women to take folic acid supplements since the vitamin needed time to build up in the body.

The summer campaign, ‘Babies Know the Facts About Folic’, has support from charities Spina Bifida Hydrocephalus Ireland and Shine Northern Ireland and will be using the hashtag #FolicFacts on social media.

It would also be promoted by pharmacies, folic acid manufacturers, doctor's surgeries and retail outlets where folic acid was sold.

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