Reducing the incidence of NTDs in Ireland

The Department of Health has opened a public consultation on the potential mandatory fortification of non-wholemeal flour with folic acid to reduce the risk of neural tube defects (NTDs), such as spina bifida. The public consultation remains open until 5 October 2026.

Ireland has a higher-than-average rate of NTDs compared with the rest of Europe. Taking a daily folic supplement prior to and during early pregnancy can prevent up to two-thirds of NTDs. 

Diet alone is generally insufficient to achieve the folate status recommended for NTD prevention. Mandatory flour fortification would help provide many women with a higher baseline intake – but the need for folic acid supplementation would continue to be stressed.

The HSE recommends that all women who may become pregnant take a folic acid supplement of 400μg daily (a higher dose  may be recommended for some women). Women who are not taking folic acid, and who plan to become pregnant, are advised to commence folic acid supplements at least 14 weeks before becoming pregnant, and continue for at least the first 12 weeks of pregnancy.

Currently, the uptake of folic acid supplementation is sub-optimal, underscoring the pressing need to better support women through improved messaging and access.

Internationally, fortification of flour with folic acid has proven to be a safe and effective way of reducing the risk of NTDs. The UK will commence the measure in December, and has estimated it will prevent 200 cases of NTDs annually (20 per cent of all cases).

The NHS’s recommendation on folic acid supplementation will remain in place.

In Ireland, a folic acid strategy steering group is leading the development of an overarching strategy to reduce the incidence of NTDs. It is comprised of relevant policy and technical experts nominated from appropriate departments and agencies. The Chief Medical Officer Prof Mary Horgan and Prof Michael Turner, Professor of Obstetrics and Gynaecology, University College Dublin School of Medicine, are among the members.

It is clear from the group’s meeting minutes that a multi-pronged approach is required, encapsulating supplementation, food fortification, enhanced health promotion and awareness, and national surveillance of NTDs, dietary folate intakes and blood folate levels.

The group has noted the critical importance of strong messaging, particularly as half of pregnancies are unplanned. It has also recognised the importance of engagement with healthcare professionals. 

One of the group’s concerns is that the public message on folic acid supplementation must not be lost if mandatory fortification is introduced.

The minutes have also referenced a cost review evaluating the potential of making folic acid supplements freely available to women. Possible influencer campaigns have been discussed, as well as communication strategies to mitigate potential misinformation and disinformation.

“Misinformation across [the] social media space is prevalent, compromising evidence-based health messages,” stated the minutes of one meeting.

Enhanced measures to reduce the rate of NTDs are long overdue. However, these comprehensive discussions are welcome evidence of a renewed focus on this vital public health issue.

The strategy is due to be submitted to the Minister by the end of the year. Meanwhile, a suite of frequently asked questions (FAQs) has been developed by a multidisciplinary team of subject matter experts to address queries relating to supplementation, food fortification, and foods rich in folate, based on the most up-to-date evidence. These FAQs have been published on the Healthy Ireland website.