Prevention of neural tube defects in the UK: A missed opportunity

In 1991 the Medical Research Council (MRC) demonstrated that folic acid taken before pregnancy and in early pregnancy reduced the risk of a neural tube defect (NTD). The concern is that most women do not take folic acid supplements (40% 1999, 27% 2012—England). Morris et al report an estimate of the number of NTD pregnancies that would have been prevented if flour had been fortified with folic acid from 1998 (as it was in the USA). Data is from congenital abnormality registers in England and Wales. The estimate for reduced risk is 27%. Based on this data the authors estimate that 2014 fewer NTD pregnancies would have occurred. The authors rightly highlight that the failure to implement folic acid fortification of flour in the UK has caused, and continues to cause, avoidable terminations of pregnancy, stillbirths, neonatal deaths and permanent serious disability in surviving children. There is an interesting accompanying editorial—Fortification of flour with folic acid is an overdue public health measure in the UK, in which other missed opportunities including the delays in limitation of smoking in …