Irish rates of neural tube defects (NTDs) such as spina bifida and anencephaly are among the highest in the world.
The FSAI's scientific report published today (4 May) recommended that one of two options be implemented to reduce this, with the findings already presented to an expert group on folic acid set up by the Minister for Health.
The first option would be a combination of mandatory fortification of bread or flour with folic acid, as well as voluntary fortification and advice for all women of childbearing age to take daily folic acid supplements.
The second option would be to simple continue voluntary fortification and policy on supplementation in place since 1993, which advises all women of child bearing age to take 400 micrograms (µg) of folic acid daily.
However the authority said there was stronger evidence to support the first option of mandatory fortification.
“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 said mandatory fortification of bread or flour to provide about 150 µg of folic acid per day in women of childbearing age could reduce the prevalence of NTDs by about 30%.
Taking folic acid before conception and during the very early stages of pregnancy can prevent up to 70% of NTDs.
Yet only 36% of women of childbearing age in Ireland have blood folate levels adequate for optimal protection against NTDs, said the report.
The authority highlighted the challenge of getting women to take the supplements recommended.
“There is particular concern that women from disadvantaged backgrounds are least likely to follow folic acid recommendations. Voluntary fortification of food with folic acid by manufacturers, which was introduced in the early 1980s, has made a significant contribution to reducing the risk of NTD-affected pregnancies in Ireland,” the authority said in the report.
“However, the approach has been shown to be less effective than mandatory fortification schemes in countries such as the US, where rates of NTDs are significantly lower than in Ireland.”
Last summer the Irish public body responsible for food safety and healthy eating awareness, Safefood, launched a campaign in response to the first increase in NTDs in Ireland since the 1990s.
Safefood's chief nutrition specialist told us at the time a key challenge in getting women to take folic acid supplements was the attitude they should only take folic acid supplements if they were planning to get pregnant.