Renewed calls for mandatory folic acid supplementation in bread

10 May 2018
Pregnant woman

Researchers have renewed calls for mandatory folic acid supplementation after a study found that very few women were abiding by national recommendations.

The study by the longitudinal study, Growing Up in New Zealand, found that 92% of women were not taking folic acid supplements according to the national recommendations.

New Zealand women are advised to take folic acid four weeks before conception and to continue this for eight weeks after conception.

A lack of folic acid in the first trimester of pregnancy can lead to neural tube defects in the baby, while too much folic acid can be associated with large-for-gestational-age birth, insulin resistance, increased adiposity and asthma in the baby.

Taking folic acid according to the recommendations was more common in women with a higher level of education, more social support, those who had a planned pregnancy and those living in more well-off households.

The research found:

  • Nearly 70% were taking insufficient folic acid supplementation
  • More than 55% were taking folic acid past the recommended 13-week gestation
  • Only 7.6% took folic acid as per the guidelines

Those not taking enough folic acid were more likely to be younger women, those with less education, of non-European ethnicities, unemployed, smokers, those who had an unplanned pregnancy and those who lived in more deprived households.

The researchers say approximately 39% of NZ women in the cohort started using folic acid supplements before pregnancy, but only 8% used it as recommended both pre- and post-conception.

They believe a lack of pregnancy planning is likely to be one of the main reasons for the low number of women who use folic acid supplementation as recommended.

They also say another reason could be the lack of adequate and complete information about the importance of taking folic acid supplementation during pregnancy.

“While almost all women in the cohort had engaged with a lead maternity carer for their antenatal care (98 %), for 8 to 14 % of them engagement with a lead maternity carer was delayed past 10 weeks of gestation,” they say.

The researchers say the impact of too much folic acid in pregnancy also needs to be looked at.

“The prevalence of extended use of folic acid supplementation in NZ is high and it will be important to determine if such use is associated with any adverse health outcomes, for example increased adiposity, insulin resistance and asthma,” they say.

The researcher say a potential reason for extended use of folic acid supplementation could be that only 40% New Zealand women use subsidised folic acid tablets.

The rest purchase one of 33 different dietary supplements available in New Zealand which don’t necessarily specify how long pregnant women should take folic acid for.

The researchers say: “Our study findings provide an important foundation upon which policy makers could develop strategies to ensure that neither insufficient nor excessive use of folic acid supplementation increases the risk of poor outcomes for the mother and/or her child.”

They say New Zealand needs to reconsider a decision not to legislate for mandatory folic acid supplementation in bread to ensure women of childbearing age have adequate supplies of this vital nutrient.

They say the NZ Health Survey (2014-15) found that only 16% of women of childbearing age had folic acid levels adequate to confer minimal risk of neural tube defects.

“These data add additional support to the implementation of the fortification programme.  NZ does need to reconsider the decision not to mandate for folic acid fortification,” they say.

Read more about this study here.