Calls for changes in UK flour to prevent birth defects (2023)

Sign up for our free Health Check email to receive exclusive analysis on the week in health

Get our free Health Check email

Proposals to fortify some flours with a vitamin which prevents babies from developing a life-threatening spinal condition do not go far enough, leading medics have warned as they said the health service could be paying out £30 million for each baby born with a neural tube defect.

Last year the Government announced that folic acid would be added to non-wholemeal wheat flour across the UK to help prevent neural tube defects.

But scientists have said that more could be done to prevent these defects – a developmental anomaly which occurs early in pregnancy.


  • Your dog isn’t your ‘child’ – it’s a dangerous animal
  • Couple leaves baby at airport check-in to avoid paying more to board flight
  • Labour MP apologises for describing Israeli government as ‘fascist’

Not getting enough folate just before, and in early pregnancy, can lead to neural tube defects and result in spinal conditions such as spina bifida or anencephaly.

(Video) Government proposes fortifying flour with folic acid to stop birth defects | 5 News

Folic acid is the man-made form of folate and it is hoped that adding the vitamin to flour will mean that women who are about to become pregnant, or who are in the early stages of pregnancy, should get some level of the vitamin when they eat bread or other foods made with flour.

It has been estimated that the current proposals will help prevent around 200 neural tube defects (NTDs) each year – around 20% of the annual UK total.

But experts have said the current proposals do not go far enough.

A higher level of fortification than the one proposed would be safe and prevent many more neural tube defects

Sir Nicholas Wald, professor of preventive medicine

They said that fortification at a level of 0.25mg per 100g of non-wholemeal wheat flour would mean people with coeliac or gluten intolerances could miss out on the benefits, as would those who mainly consumed carbohydrates though rice.

Sir Nicholas Wald, professor of preventive medicine, University College London, said that fortification of about 1mg of folic acid per 100g of flour and rice would mean that some 800 cases could be prevented each year – around 80% of the annual total.

He said that simply advising women to take folic acid before pregnancy “does not work”, adding: “So the only alternative is fortification of a staple food which has been introduced in about 80 countries around the world.”

Sir Nicholas added that with “fully effective fortification” there would be no need for women to take a folic acid supplement when they were trying to, or were pregnant.

This is not a trivial condition. It is a serious condition. And it has major, major lifelong implications for the baby affected and for that baby's family. Prevention is by far to be preferred than what is a terrible condition

(Video) Farmer's Pig Gives Birth To Human Baby, He Takes A Closer Look And Starts Crying

Neena Modi, professor of neonatal medicine

All flour and rice could be fortified unless sold with an “unfortified health alert” label, he added.

“The issue here is fully effective fortification rather than just effective fortification,” he told a Science Media Centre briefing.

“Last year, the Government made the welcome decision that there would be mandatory fortification of wheat flour, not wholemeal, in Britain.

“A higher level of fortification than the one proposed would be safe and prevent many more NTDs.”

Neena Modi, professor of neonatal medicine at Imperial College London and president-elect of the European Association of Perinatal Medicine, added: “I have personally experienced what a tragedy it is to witness the birth of a baby with a neural tube defect.

“In the UK, we have a pregnancy neural tube defect prevalence that is one of the highest in Europe.

“Now, a large number of these are terminated.

(Video) Epilepsy in Pregnancy - ILAE Eastern Mediterranean & Africa 25 November Webinar (English)

“But of course the live-born babies require surgery, and often multiple surgeries, and they invariably have substantial lifelong health care needs.

There are scientific reasons why we should be administering the correct dose to get the maximum prevention, there are medical reasons, there are ethical reasons and there are economic reasons

Dame Lesley Regan, professor of obstetrics & gynaecology

“So this is not a trivial condition. It is a serious condition. And it has major, major lifelong implications for the baby affected and for that baby’s family.

“Prevention is by far to be preferred than what is a terrible condition.”

Dame Lesley Regan, professor of obstetrics and gynaecology at Imperial College’s St Mary’s Hospital Campus and honorary consultant in gynaecology at Imperial College NHS Trust, said: “There are scientific reasons why we should be administering the correct dose to get the maximum prevention, there are medical reasons, there are ethical reasons and there are economic reasons.

“Wearing my NHS Resolution board hat, we are seeing now that children that have been damaged or who are born damaged, whether this is because of an accident that happens during the pregnancy or the labour, or because of, for example, a neural tube defect … their lawyers are basically ensuring that they will have payouts for the rest of their life, and rightly so because if I was a mother who had delivered a baby with a severe neural tube defect I would want that help and support.

“So they’re going to have complex and multiple episodes of surgery and they’re also going to need caring facilities for the rest of their lives.

And so all we have to do is thank the Government and the policymakers for agreeing to folic acid fortification, but let's do it at the right dose, because it makes no sense to do something the wrong way round or half-heartedly

(Video) Folic Acid in the Prevention of Birth Defects

Dame Lesley Regan, professor of obstetrics & gynaecology

“So we’re talking about, for a single baby, payouts of £30 million over a life course.

“This is just not sustainable. The NHS Resolution obstetric litigation costs – not of course, all for neural tube – but for litigation for obstetric disasters is the second most expensive item on the Chancellor’s list.”

She added: “There are now 80 countries in the world who have adopted the sensible scientifically and medically based approach and we’re lagging behind with them.

“And so all we have to do is thank the Government and the policymakers for agreeing to folic acid fortification, but let’s do it at the right dose, because it makes no sense to do something the wrong way round or half-heartedly.”

We recommend that fortification of flour is set at a level sufficient to prevent about four out of five neural tube defects, namely 1mg of folic acid per 100g of flour

Royal College of Obstetricians and Gynaecologists

Sir Nicholas said “we are past nanny state arguments” and the issue now is what level of fortification should be set.

Concerns have previously been raised that higher levels of fortification may make a vitamin B12 deficiency worse, but he said that this was based on “flawed analysis” and the concern had now been dismissed.

The Royal College of Obstetricians and Gynaecologists (RCOG) said in a statement: “We are concerned about the proposed levels of fortification.

(Video) Prevention of Spina Bifida in UK and Epidemic in Ukraine


  • Charity boss speaks out over ‘traumatic’ encounter with royal aide
  • Ukraine war’s heaviest fight rages in east - follow live

“As the open consultation to amend the Bread and Flour Regulations set out, modelling predicts that proposed levels of folic acid fortification will prevent around 20% of neural tube defects. We recommend that fortification of flour is set at a level sufficient to prevent about four out of five neural tube defects, namely 1mg of folic acid per 100g of flour.

“We encourage the Government to reconsider the proposed level of fortification of flour with folic acid, and SACN (the Scientific Advisory Committee on Nutrition) to review the evidence informing the Tolerable Upper Intake Level of folic acid.”


Which food additive was added to food to help prevent birth defects? ›

Folic acid fortification: Folic acid is a B vitamin that can help prevent certain birth defects, including NTDs. In 1998, the U.S. Food and Drug Administration required that folic acid be added to enriched grain products (such as bread, pasta, rice, and cereal). This is called fortification.

What supplement can prevent prevent or reduce the risk of neural tube defects in babies? ›

Folic acid is the only form of folate that has been shown to help prevent neural tube defects. Folic acid is a specific form of folate that does not generally occur naturally. You can find folic acid in vitamins, fortified foods like rice, pasta, and bread, and some breakfast cereals that are labeled “enriched.”

What kind of vitamin helps prevent this kind of defect in babies? ›

When the baby is developing early during pregnancy, folic acid helps form the neural tube. Folic acid is very important because it can help prevent some major birth defects of the baby's brain (anencephaly) and spine (spina bifida). The neural tube forms the early brain and spine.

What is added to flour to prevent birth defects? ›

Folic acid is added to flour in more than 80 countries - and when it was added to bread in Australia, neural tube defects fell by 14%.

Is flour in the UK fortified with folic acid? ›

Folic acid added to flour to prevent brain and spinal conditions in foetuses. Folic acid to be added to non-wholemeal flour across the UK to help prevent life-threatening brain and spinal conditions in foetuses.

What are the 4 main causes of birth defects? ›

Smoking, drinking alcohol, or taking certain drugs during pregnancy. Having certain medical conditions, such as being obese or having uncontrolled diabetes before and during pregnancy. Taking certain medications, such as isotretinoin (a drug used to treat severe acne). Having someone in your family with a birth defect.

What increases chances of Down syndrome? ›

Advancing maternal age.

A woman's chances of giving birth to a child with Down syndrome increase with age because older eggs have a greater risk of improper chromosome division. A woman's risk of conceiving a child with Down syndrome increases after 35 years of age.

What foods decrease neural tube defects? ›

You can also eat a diet rich in folate. Folate can be found in foods like beans, peas, and lentils; oranges and orange juice; asparagus and broccoli; and dark leafy green vegetables such as spinach and mustard greens.

What mineral helps prevent neural tube defects? ›

All women of reproductive age should get 400 micrograms (mcg) of folic acid each day, in addition to consuming food with folate from a varied diet, to help prevent neural tube defects (NTDs). NTDs are major birth defects of the baby's brain (anencephaly) and spine (spina bifida).

What week do neural tube defects occur? ›

Adequate folate levels are critical during the early days of the developing embryo, particularly the 3rd and 4th week, the period in which neural tube defects occur and when many women won't know they are pregnant.

What foods are high in folic acid UK? ›

Good sources of folate

brussels sprouts. leafy green vegetables, such as cabbage, kale, spring greens and spinach. peas. chickpeas and kidney beans.

Can you tell if your baby is disabled before it's born? ›

Are all birth defects discovered before a baby is born? It's not always possible to detect all birth defects in utero. However, high-resolution ultrasounds done by certified prenatal ultrasound groups make it possible to diagnose defects that will cause a significant impact before birth.

How can I prevent birth defects after 35? ›

Get early and regular prenatal care. Take prenatal vitamins every day that contain 0.4 milligrams of folic acid, which can help prevent certain birth defects. Start at least 2 months prior to conception. Eat a healthy, well-balanced diet that includes a variety of foods.

What is flour fortified with UK? ›

Since the Second World War, flour has been fortified with calcium, iron, niacin and thiamin during milling to support the nation's health.

Which countries add folic acid to flour? ›

What is actually happening to the flour? Countries such as New Zealand and Canada have already introduced flour fortification with folic acid though it is too early to see the benefits it may have. The fortification process itself involves adding additional folic acid to non-wholemeal flour which has been milled.

Is all flour in the US fortified? ›

Almost 95 percent of the white flour in the United States is enriched with iron and four of the B vitamins: thiamin, niacin, riboflavin and folic acid. By contrast, fortified flour may contain folic acid in amounts that exceed those present in whole-wheat flour.

Why is wheat flour fortified in the UK? ›

As a result, to protect the public's health, calcium, iron, niacin, and thiamin are added all non-wholemeal flour that is produced in or imported into Great Britain.

Is UK bread fortified with calcium? ›

Milk and milk products are the major source in the British diet. White and brown bread (by law fortified with calcium), cereal products, vegetables and hard water also provide significant amounts. A healthy balanced diet should provide all the calcium we need.

What is the number 1 birth defect? ›

The most common severe birth defects are heart defects, neural tube defects and Down syndrome.

What is the most common birth defect in the US? ›

Congenital heart defects are the most common type of birth defect in the United States, affecting nearly 1 percent of, or about 40,000, births per year, according to the Centers for Disease Control and Prevention.

Can birth defects be caused by the father? ›

Based on the results of our meta-analysis, young fathers (< 20 years) could increase the risk of urogenital abnormalities and chromosome disorders in their offspring, whereas old fathers (≥ 40 years) could increase the risk of cardiovascular abnormalities, facial deformities, urogenital abnormalities, and chromosome ...

How many babies in the US are born with birth defects percentage? ›

About 1 in 33 babies (about 3 percent) is born with a birth defect in the United States each year. Some birth defects don't need treatment or can be treated easily.

Can sperm cause birth defects? ›

The answer is no. The structure of the sperm does not affect the baby in terms of causing any defects physically or mentally. The only issue that can cause due to abnormal sperm morphology is that, depending upon the percentage and the density of abnormal sperms, the pregnancy can be delayed or not occur altogether.

Can stress cause birth defects? ›

A growing body of research demonstrates that stress before and during pregnancy is associated with poor birth outcomes and subsequent poor health outcomes for children.

Which parent carries the gene for Down syndrome? ›

To date, no behavioral activity of the parents or environmental factor is known to cause Down syndrome. After much research on these cell division errors, researchers know that: In the majority of cases, the extra copy of chromosome 21 comes from the mother in the egg.

What gender is most likely to get Down syndrome? ›

Abstract. In a sample of 75 children with trisomy for chromosome 21, or Down syndrome, there were 42 males and 33 females. The sex ratio was 1.30 which is statistically not significant (p greater than 0.05).

Does father's age affect Down syndrome? ›

Dr. Fisch and his colleagues found that the rate of Down syndrome steadily increased with advancing paternal age for the maternal age group of 35 to 39 years. The greatest increase, however, was seen in the maternal age group of 40 years and older with increasing paternal age.

What cereal is best when pregnant? ›

This is important to reduce the risk of birth defects. Cereals containing high fiber and 100 percent of your daily folic acid need include: Kellogg's All Bran, Total Wheat Flakes, Total Corn Flakes, TotalRaisin Bran, Product 19, Multigrain Cheerios, and Smart Start.

What are 3 risk factors for developing a neural tube defect? ›

Risk factors
  • Folate deficiency. Folate, the natural form of vitamin B-9, is important to the development of a healthy baby. ...
  • Family history of neural tube defects. ...
  • Some medications. ...
  • Diabetes. ...
  • Obesity. ...
  • Increased body temperature.
Jan 8, 2022

Can neural tube defects be seen on ultrasound? ›

Ultrasound examination is an effective modality for prenatal diagnosis of neural tube defects (NTDs), which are the second most frequent category of congenital anomalies after congenital heart disease. Imaging has largely replaced measurement of maternal serum alpha-fetoprotein (MSAFP) for NTD screening.

Does Iron prevent neural tube defects? ›

Our results demonstrate that iron supplementation can prevent NTDs and forebrain truncations in the Fpn1ffe model. Surprisingly, high levels of iron supplementation and iron overload can cause folate deficiency. If iron is essential for neural tube closure, it is possible that iron deficiency might contribute to NTDs.

Does vitamin C prevent neural tube defects? ›

Micronutrients with antioxidant capacity such as vitamins C and E may reduce NTD risk (Loeken, 2004). Lower vitamin C serum levels have been reported in women with histories of NTD-affected pregnancies (Smithells and others, 1976).

Does folic acid prevent Down syndrome? ›

An adequate intake of folic acid during pregnancy, believed to protect against neural tube defects (NTDs) in babies, may also help prevent Down's syndrome, researchers report in The Lancet​ this week.

Can a baby survive a neural tube defect? ›

This occurs when part of a baby's skull does not form properly, and part of the brain is outside of the skull. Babies with this type of neural tube defect usually die. Babies who survive may have physical and mental handicaps.

During which trimester is the fetus at greatest risk of malformations? ›

Harmful exposures during the first trimester have the greatest chance of causing major birth defects. This is because many important developmental changes take place during this time. The major structures of the body form in the first trimester. These include the spine, head, arms and legs.

What are the signs of neural tube defects in pregnancy? ›

The symptoms associated with NTDs vary depending on the specific type of defect. Symptoms include physical problems (such as paralysis and urinary and bowel control problems), blindness, deafness, intellectual disability, lack of consciousness, and, in some cases, death. Some people with NTDs have no symptoms.

Are bananas full of folic acid? ›


They're especially high in folate and can easily help you meet your daily needs when paired with a few other folate-rich foods. A medium banana can supply 23.6 mcg of folate, or 6% of the DV ( 36 ). Bananas are high in other nutrients as well, including potassium, vitamin B6, and manganese ( 36 ).

Does peanut butter have folic acid? ›

Folic acid is the synthetic B vitamin form that is used in vitamin supplements and added to fortified foods. Folate is the B vitamin form found naturally in foods.
Folic Acid and Folate Values for Selected Foods.
FoodServing SizeFolic Acid/Folate per Serving* (mcg)
Peanut butter1 tablespoon12 - 15
Green Peas, cooked (frozen or canned)1 cup75 - 94
36 more rows

Does oatmeal have folic acid? ›

Oats are a great source of vitamin B6 and folic acid. Vitamin B6 helps the body to use and store energy from food, which is why oats are perfect morning fuel. They also contain folic acid which helps the function of your immune system.

What vitamin prevents birth defects? ›

Folic acid is very important because it can help prevent some major birth defects of the baby's brain (anencephaly) and spine (spina bifida). The neural tube forms the early brain and spine.

What are the main cause of disability before birth? ›

Low birthweight, premature birth, multiple birth, and infections during pregnancy are associated with an increased risk for many developmental disabilities. Untreated newborn jaundice (high levels of bilirubin in the blood during the first few days after birth) can cause a type of brain damage known as kernicterus.

How can I reduce my risk of Down syndrome during pregnancy? ›

Commit to Healthy Choices to Help Prevent Birth Defects
  1. Plan ahead. Get 400 micrograms (mcg) of folic acid every day. ...
  2. Avoid harmful substances. Avoid alcohol at any time during pregnancy. ...
  3. Choose a healthy lifestyle. Keep diabetes under control. ...
  4. Talk with your healthcare provider.

Is 37 too old to get pregnant? ›

Age is one of the key factors that predict your ability to conceive. Your fertility starts to decline at age 30 and keeps on dropping steadily until you hit menopause. That said, it's not only possible to deliver a healthy baby after age 35, it's quite common.

Is 38 too old to have a baby? ›

After age 35, there's a higher risk of pregnancy-related complications that might lead to a C-section delivery. The risk of chromosomal conditions is higher. Babies born to older mothers have a higher risk of certain chromosomal conditions, such as Down syndrome. The risk of pregnancy loss is higher.

What preservative is used in baby food? ›

Preservatives — The only 'preservative' you should see in baby food is Vitamin C, but jarred food can contain a variety of listed or unlisted preservatives to make the food shelf stable. Contaminants — Contaminants can make their way into store-bought baby foods and can even show up in the water used to make it.

What are the vitamin C for baby in food? ›

Breastmilk, infant formula, and whole foods, such as bell pepper, strawberries, and papaya, are the best sources of vitamin C for your baby. Vitamin C supplements aren't appropriate for infants unless recommended by a healthcare provider.

What was the first food additive? ›

The first deliberate use of a food additive was likely salt to preserve foods such as fish and meat, which works by dehydrating the food to limit bacterial growth. However, it wasn't until the 19th century that the microbial cause of food spoilage was understood.

What is the least toxic baby food? ›

The least-contaminated foods for babies, they say, are:
  • bananas.
  • grits.
  • baby food meat brands.
  • butternut squash.
  • lamb.
  • apples.
  • pork.
  • eggs.

Is Mcdonalds a preservative? ›

We removed calcium propionate, an artificial preservative, from our regular, Quarter Pounder and Big Mac buns. The buns on our classic burgers are toasted and have no artificial flavors or added colors from artificial sources, and now also have no artificial preservatives.

What baby food is recalled 2022? ›

Similac, Alimentum and EleCare Recall

February 17, 2022: Abbott has voluntarily recalled powdered formulas, including Similac, Alimentum, and EleCare, manufactured in their Abbott Nutrition facility in Sturgis, MI.

What brands of baby food have heavy metals? ›

UPDATED 2022: Baby Foods Toxic Heavy Metals List
  • Beech-Nut.
  • Gerber.
  • Hain Celestial Group (Earth's Best Organic)
  • Nurture (Happy Family Organics and Happy BABY)
  • Plum Organics.
  • Sprout Foods (Sprout Organic Food)
  • Walmart (Parent's Choice)
Oct 21, 2022

Does oatmeal have heavy metals? ›

You see, we know that oats can have residue from arsenic, lead, and cadmium. They also can have glyphosate, paraquat, and mycotoxins, all of which can harm your child's health.

What are 3 foods that contain vitamin C? ›

Fruits and vegetables are the best sources of this vitamin.
  • Citrus (oranges, kiwi, lemon, grapefruit)
  • Bell peppers.
  • Strawberries.
  • Tomatoes.
  • Cruciferous vegetables (broccoli, Brussels sprouts, cabbage, cauliflower)
  • White potatoes.

Can babies take zinc? ›

Zinc is important at all stages of your child's development. When your child is about 6 months old, you can start giving solid foods with zinc to your child. Children 7 to 24 months need 3 mg of zinc each day.

Which food is richest in vitamin C? ›

Good sources include:
  • citrus fruit, such as oranges and orange juice.
  • peppers.
  • strawberries.
  • blackcurrants.
  • broccoli.
  • brussels sprouts.
  • potatoes.

What is the number 1 food additive in the United States? ›

Salt, sugar, and corn syrup are by far the most widely used additives in food in this country. What is a food additive?

What is the world's oldest food preservative? ›

Drying is the oldest method of food preservation. This method reduces water activity which prevents bacterial growth.


1. Preventing and Treating the Leading causes of Death in the UK | Dr Michael Greger
(College of Naturopathic Medicine)
2. Preventing Birth Defects and Saving Lives: Folic Acid-Preventable Spina Bifida, Anencephaly
3. Clash of the Titans: Folic acid fortification absolutely needed for prevention of ONTDs
(International Society for Pediatric Neurosurgery)
4. What to Eat During Pregnancy w/ Lily Nichols | Ep. 59 Just Ingredients Podcast, Karalynne Call
(Just Ingredients)
5. Treat High Blood Pressure's Root Cause by having a Complete Cardiac Examination
(Dr. Pradip Jamnadas, MD)
6. Folic Acid Is Vital To Getting Pregnant | Good Morning Britain
(Good Morning Britain)
Top Articles
Latest Posts
Article information

Author: Gov. Deandrea McKenzie

Last Updated: 02/22/2023

Views: 5909

Rating: 4.6 / 5 (66 voted)

Reviews: 81% of readers found this page helpful

Author information

Name: Gov. Deandrea McKenzie

Birthday: 2001-01-17

Address: Suite 769 2454 Marsha Coves, Debbieton, MS 95002

Phone: +813077629322

Job: Real-Estate Executive

Hobby: Archery, Metal detecting, Kitesurfing, Genealogy, Kitesurfing, Calligraphy, Roller skating

Introduction: My name is Gov. Deandrea McKenzie, I am a spotless, clean, glamorous, sparkling, adventurous, nice, brainy person who loves writing and wants to share my knowledge and understanding with you.