Calls to add folic acid to flour to prevent birth defects

Dr Linda de Caestecker, director for public health for NHS Greater Glasgow and Clyde, said Scotland should become the first UK nation to bring in legislation requiring flour be fortified with folate.

Is is understood 70 other countries have already made the move, but the UK Government is not currently planning to introduce the policy, despite recommendations from the Food Standards Agency.

The Scottish Government has asked Food Standards Scotland to look into the policy, but a report is not expected back until the spring.

More children in Scotland are born with spina bifida - a condition which can be prevented if mothers have enough folic acid in their system - than anywhere else in the UK.

And Dr de Caestecker, who also served as deputy director of the International Federation of Gynaecology and Obstetrics last year, said folic acid fortification had been practice in the US since 1998.

She said: “Let’s get on and do it. The evidence is strong it is a really good public health intervention. Let’s make it happen in Scotland.”

Folic acid, or vitamin B9, significantly reduces the risk of neural tube defects in infants.

Embryos develop a structure called the neural tube, which will eventually become the brain and spinal cord, a few weeks after conception.

When this does not develop properly infants can suffer several potentially devastating health problems including spina bifida, which can lead to mobility problems, bladder and bowel issues and brain damage.

There is also risk of miscarriage or the baby dying shortly after birth.

Dr de Caestecker said: “It is a horrible thing for a mother. Sometimes it can mean a late termination which means a woman going into labour.

“That is a very distressing situation.

“But it could be that that was prevented and she would have had a normal pregnancy.”

The potential for neural tube defects to develop can be reduced by 72 per cent if a mother has enough folic acid in her system.

Women trying to get pregnant are currently advised to take folic acid so their levels are high enough.

But Dr de Caestecker believes this system best suits women who are well-educated, well-advised and well-informed.

For others, including the parents who fall pregnant unexpectedly, by the time they know they are carrying a child it may be too late.

Fortifying grain, she argues, is a way to ensure levels of vitamin B9 are higher in general.

Dr de Caestecker said: “There is no serious, evidence based, scientific case against folate fortification.

“It is a great opportunity to be the first nation in the UK to leave the starting gate and bolt toward a future of better pregnancy outcomes, social justice among parents and babies less likely to be burdened with birth defects that could have been prevented.”

Every week in Scotland, another pregnancy is affected by spina bifida or hydrocephalus, which can affect the brain.

One family campaigning for folic acid to be added to flour is Margaret Baillie and her son Alistair.

Alistair suffers from spina bifida and hydrocephalus.

Margaret did not take folic acid when she was pregnant with him more than 20 years ago, as no one advised her to do so.

She said she only learned it could have prevented her son’s disabilities when she considered trying for another child.

Alistair, a college student from Hamilton, has now sued an assignment to argue for the fortification of flour with folate to prevent others being affected by these defects.

He said: “A lot of people do not know a lot about it. Sometimes it is hard because people do not understand why I am in a wheelchair.”

Margaret said: “It does not do harm to anyone else. If it is going to help reduce the amount of birth defects, why not?”

Andrew Wynd, chief executive of charity Spina Bifida Hydrocephalus Scotland, said: “We were disheartened earlier this year when plans for implementation in England were firmly halted but folic acid fortification remains particularly relevant in Scotland as more children are born with spina bifida in Scotland than anywhere else in the UK.”

A Scottish Government spokesman said: “We support the fortification of flour with folic acid as a way of reducing neural tube defects and have written to the UK Government as any such measure would be easier introduced, and provide benefits, across the United Kingdom.

“In the absence of a positive response, Food Standards Scotland have been asked to provide advice around fortification of flour with folic acid on a Scotland-only basis.

“That is expected next month.”