Mandatory folic acid in bread will reduce serious birth defects, report finds



A report released on Friday has found that mandatory folic acid fortification in bread is definitely linked to lower rates of neural tube defects in babies. Dr Andrew Marshall is a paediatrician for the Capital & Coast District Health Board and an advocate of mandatory folic acid.

A high level health report supports adding the B vitamin folic acid to all packaged bread to reduce serious birth defects.

New Zealand opted not to make fortification mandatory in 2009, despite evidence it would help to reduce cases of neural tube defects (NTDs) in babies. 

​But the latest Ministry of Health report provided overwhelming evidence fortification was safe for the general population and the benefits outweighed any potential risks.

Doctors and scientists are calling on the Government to act swiftly. 

*Mums not following advice to boost iodine and folic acid

Wellington Regional Hospital paediatrician Andrew Marshall called on the Government to make fortification mandatory.

Folic acid supplementation can reduce severe birth defects, should be mandatory, report finds.


Folic acid supplementation can reduce severe birth defects, should be mandatory, report finds.

“I call on the current government to implement mandatory folic acid fortification in New Zealand, joining the 80 countries who already do this.”

He said every year there were an estimated five to 15 new cases of NTD that would have been prevented if mandatory fortification had gone ahead from 2009.

NTDs are severe birth defects that can lead to miscarriage, stillbirth, or lifelong and usually serious disabilities which happen in the first month of pregnancy.

In 2013, there were 51 cases of NTD pregnancies. Of these 18 were live births, six were still births and 27 were terminated. 

Marshall said the impact of each case was devastating for the child and families affected. 

“Those of us working at the coal-face see the chronic pain and degree of disability of children who have spina bifida, the impact on their whānau, and the high preventable costs of multiple surgeries, medical, educational and social supports required for them.”

The Ministry of Health-commissioned report by former chief science advisor Sir Peter Gluckman and the Royal Society Te Apārangi found mandatory fortification was unequivocally associated with lower rates of neural tube defects.

Most women of child-bearing age did not have sufficient levels of folate recommended by the World Health Organisation (WHO) to reduce the risk of a NTD-affected pregnancy.

A population survey in 2014-15 found just 16 per cent of Kiwi women in this group met the recommended folate levels.

Ministry of Health guidelines recommend women planning a pregnancy start taking folic acid at least four weeks before conception, and continue through the first twelve weeks of pregnancy.

But about 40 per cent of pregnancies in New Zealand were unplanned and there were many women who remained unaware of the importance of folate supplementation. 

“Starting folic acid supplementation once pregnancy has been confirmed may be too late to reduce the risk of an NTD being developed,” the report said. 

The solution to prevent NTD pregnancies was fortification. 

A large number of studies from countries with mandatory flour fortification “categorically show reductions in NTD rates following introduction of the programme”, the report found. 

Alternatively there was little evidence of negative health outcomes.

Taking folic acid supplements at the recommended doses in pregnancy had no adverse effects on pregnancy outcome or the child’s health.

There was no strong evidence supplementation would increase the risk of neurological/cognitive decline, diabetes, or cardiovascular disease.

Genetic studies had provided limited evidence that relatively higher blood folate may be associated with lower risks of breast and total cancers and higher risks of prostate and colorectal cancer.

Massey University Centre for Public Health Research (CPHR) associate professor Barry Borman​ said the Government had been influenced by “unsubstantiated theoretical risks and the need to appease the food industry” over the proven benefits of mandatory folic acid fortification.

In 2016, 38 per cent of packaged bread was fortified despite a baking industry target to fortify 25-50 per cent of products with folic acid.

University of Otago human nutrition head of department associate professor Lisa Houghton said the voluntary approach had failed women. 

“Despite an increase in breads containing folic acid, there has been no improvement in the folate status of women.





 – Stuff


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