(Neural tube defects and periconceptional folic acid in England and Wales: retrospective study)

(Commentary: Food should be fortified with folic acid)

Foods should be fortified with folic acid to ensure that women considering trying for a baby receive the recommended levels of this important nutrient, say commentators in this week's BMJ. The authors, commenting on an analysis of the numbers of pregnant mothers taking folic acid, base their suggestion on the fact that forty per cent of pregnancies in the UK are unplanned and therefore these women are unlikely to have taken the advised periconceptional folic acid supplementation.

Professor Eva Alberman and Joan Noble from the Wolfson Institute of Preventive Medicine say that despite expensive and large scale health education campaigns to encourage mothers to take folic acid before conception, the proportion of women doing so is not much more than 30 per cent. They say that because so many pregnancies are unplanned this is hardly surprising and therefore a better means of ensuring women receive their recommended daily dose of folic acid is to implement a policy of fortifying foods with the nutrient.

Neural tube defects (such as spina bifida) have been shown to be reduced by mothers taking periconceptional supplementation. In a separate paper, also in this week's BMJ, Dr Rezan Kadir and colleagues from the Royal Free and University College Medical School report that neural tube defects have been decreasing since the early 1970s. In 1992 the Expert Advisory Group in the United Kingdom recommended that women who were trying to conceive should take 0.4mg of folic acid each day.

Kadir et al assessed whether there had been any change in the incidence of neural tube defects since this recommendation was made and they found that the rate of decline in the numbers of babies (births, stillbirths and terminations) with such defects had slowed. They say that this may be because mothers are not taking the supplement over the correct period; it may not be taken by those at highest risk, or the recommended daily dose may be too low. They also speculate that the incidence of such defects has reached such a low level (the incidence of spina bifida fell from 215/100,000 in 1972 to 38/100,000 in 1991) that it is not possible to achieve further reduction through supplementation.

They conclude that there is a need for continued health education on the benefits of folic acid both before pregnancy and immediately after conception in unplanned pregnancies.

Contact for Paper:

Mr Demetrios Economides, Senior Lecturer, Department of Obstetrics and Gynaecology, Royal Free and University College Medical School, London

Contact for Commentary:

Joan Noble, Administrator, Department of Enviromental and Preventive Medicine, Wolfson Institute of Preventive Medicine, St Bartholemew's and Royal London School of Medicine and Dentistry, London