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jagged little pill

A baby might be the last thing on your mind - but you still need to start taking folic acid

Ireland has some of the highest rates of neural tube defects in the world, but the mandatory fortification of food could reduce our rates by 30%.

TAKING FOLIC ACID every day helps prevent your unborn baby from developing serious and possibly fatal conditions.

Medical experts agree it’s a “no-brainer” when it comes to including it in your daily regime.

But what if you’re not pregnant? And not evening thinking of becoming pregnant? It might even be quite possible the thought of a baby makes you want to run screaming for the hills.

But despite this, if you’re of childbearing years – and are capable of getting pregnant – you should be taking 400 micrograms of folic acid daily right now, medical professionals say.

shutterstock_286988390 Shutterstock / Kichigin Shutterstock / Kichigin / Kichigin

A new report from the Food Safety Authority of Ireland (FSAI), shows Ireland’s rates of neural tube defects (NTDs) have risen slightly in recent years. (And we already have some of the highest rates in the world). But only one in three Irish women of childbearing age have enough folic acid in their system to help prevent against NTDs and “very few women take folic acid supplements as recommended”, the report says.

One in five women don’t consume folic acid at all.

However, the report found that if the mandatory fortification of food with folic acid came into place, then the rate of NTDs in Ireland could be reduced by about 30%.


NTDs include spina bifida – a birth defect where there is incomplete closing of the backbone and membranes around the spinal cord – and anencephaly, a fatal condition where the baby is born without parts of the brain and skull.

Taking folic acid helps protect against 70% of these birth defects, says Dr Mary Flynn, chief specialist in public health nutrition at the FSAI.

But it’s not something you can wait to take when you find out you’re pregnant.

shutterstock_25087573 Shutterstock / Cheryl Casey Shutterstock / Cheryl Casey / Cheryl Casey

The neural tube closes in the first few weeks of pregnancy (by day 28 post-conception) which is when folic acid is needed.

However, most women don’t find out they are pregnant until at least 14 days after they conceive – if not later – meaning it’s already too late to build up enough folic acid to protect against NTDs.

“When you walk into a pre-natal clinic full of women who are three months pregnant, you’ll find they’re all on folic acid,” says Flynn.

But it’s too late to protect that pregnancy against neural tube defects by then.

High levels

Several countries, including the US and Canada, have been fortifying their food – usually bread – with folic acid since the 1990s.

But most of Europe has yet to introduce a similar practice.

According to the FSAI, the mandatory fortification of food was considered here in 2008, but it was shelved when studies found Ireland’s rate of NTDs had dropped to levels similar to North America.

It’s believed our levels dropped because the number of fortified foods on the market had increased, in anticipation of mandatory fortification coming into place.

However, since plans to introduce mandatory fortification were shelved, North American levels have continued to drop to around 0.7 per 1,000, while Irish levels have risen.

In 2009 it was 0.92 per 1,000. It rose to 1.04 in 2010 and then 1.17 in 2011. At the same time, foods on the market that are fortified with folic acid have decreased.

“It may not sound like a big increase, but when you think that there are between 65,000 and 75,000 births in Ireland every year, it is significant,” says Flynn.

Mandatory fortification

As a result, the FSAI wants to see mandatory food fortification put in place.

“What we would love to do is put in a low dose in something like flour or bread which would reach all women,” says Flynn.

shutterstock_352819853 Shutterstock / Gamzova Olga Shutterstock / Gamzova Olga / Gamzova Olga

However, this could take several years to put in place and it would need to happen at a European level to be effective. “Mandatory fortification of flour or bread with folic acid would require legislation,” the report says.

An implementation programme would be needed to address legislation, consumer acceptability and consumer choice, technical issues, cost, and trade implications.

Even with fortification, supplements are still required to ensure women get the required 400 micrograms of folic acid daily. Which brings us back to that pill.

Changing the mindset

Here’s the catch – at least 50% of pregnancies in Ireland are unplanned, meaning those women are even less likely to be on folic acid. “This is why all women who could become pregnant need to be taking folic acid daily,” says Flynn.

Young women tell me that if their boyfriends knew they were taking folic acid they would run a mile, thinking they wanted to have a baby. That’s something we have to get over. Taking folic acid needs to be as normal as drinking water.

Folic acid should be taken for at least three months before pregnancy, according to Michelle Gray, dietician with The First 1,000 Days – a movement to promote healthy eating in pregnancy and early childhood.

People were more aware of the need to take folic acid a few years ago. But in recent years, less money has been put into raising awareness.

According to the FSAI report, there has been a marked decrease in public campaigning on the issue in the last decade, most likely due to the financial crisis.

From 2007, there were no national campaigns promoting the use of folic acid until Safefood ran a four-week campaign last July.

“We need an ongoing campaign. We need ongoing awareness,” says Flynn. “We need to change the national mindset.”

Gray agrees: “This is never something we were told about when we were in school, so we’ve started bringing up folic acid in our talks at secondary schools.

But it is hard for young women in particular to get into that mindset. They are so far away – in their minds – from having a baby.

Read: Even if you aren’t actively trying for a baby, you might need to take folic acid

 Read: I carried my baby to term, knowing when he was born I would have to bury him

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