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Failure to progress folic acid fortification ‘a tragedy’, clinicians warned CMO 

By Catherine Reilly - 09th May 2024

Vitamin B9 supplement folic acid bottle on yellow background 3d illustration. Folic acid aid proper blood formation and prevention of some serious birth defects.

Failure to fortify foodstuffs with folic acid “is more than a missed opportunity, it is a tragedy”, senior clinicians in the HSE National Women and Infants Health Programme (NWIHP) warned the Chief Medical Officer (CMO).

In September 2023, NWIHP Clinical Director Dr Cliona Murphy and Neonatology National Clinical Lead Dr John Murphy wrote to CMO Prof Breda Smyth stating: “Ireland has a high rate of neural tube defects relative to our European neighbours and has a high rate of live born children affected. The burden of neural tube defects on affected individuals and families is heavy with lifelong pain, repeated operations, and mobility issues.”

They included a position statement supporting folic acid flour fortification published by the European Board and College of Obstetrics and Gynaecology, which was co-authored by key clinical leaders in Ireland.

The NWIHP clinicians noted that folic acid supplementation is advocated for women in Ireland planning a pregnancy. However, many pregnancies are unplanned and women at most risk – those from lower socioeconomic and disadvantaged populations – are least likely to take supplements. In addition, voluntary fortification of foodstuffs in Ireland has declined.

“Fortification of foodstuffs has the potential to reduce the prevalence of neural tube defects by up to 70 per cent. Over 80 countries have been fortifying their flour with folic acid and have seen declines in the prevalence of neural tube defects.

“Overestimation of theoretical potential harm of fortification has stalled progress in this area. Failure of countries to fortify is more than a missed opportunity, it is a tragedy,” added the correspondence obtained by the Medical Independent (MI) under Freedom of Information law.

In 2021, the UK government announced it would introduce mandatory folic acid fortification of non-wholemeal wheat flour to help prevent neural tube defects, following a public consultation in 2019. In late 2022, a specific proposal for the addition of 250 micrograms of folic acid per 100 grams of non-wholemeal wheat flour was included in a broader consultation on the UK’s bread and flour regulations.

The proposed legislative changes are expected this year with a 24-month adjustment period for industry. NHS advice on supplementation will continue.

In February, the then Minister of State at the Department of Health, Hildegarde Naughton, informed Social Democrats Deputy Róisín Shortall that food consumption patterns and preferences, supply chain issues, and resources and timing, would need to be deliberated prior to any further consideration of mandatory fortification.

“The issue is further complicated by the lack of any national mills in Ireland and reliance on the UK for up to 70 per cent of its flour supply,” stated Minister Naughton.

A Department spokesperson told MI it established an interdepartmental group earlier this year to review the recommendations in the 2019 folic acid policy committee report.

“The interdepartmental group is in the process of drafting an outline of regulatory and non-legislative measures that need to be undertaken to inform the Minister for Health on the best course of action in respect of preventing neural tube defects in Ireland.”

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