To think it's a disgrace that the UK still doesn't add folic acid to flour?

[LisaSimpsonsbff]

I'm a long-term obsessive user of the conception forums and I was a bit shocked this morning to see two separate posts in which it was clear that posters thought the advice to take folic acid before pregnancy was to help you conceive (and therefore not important if you weren't having problems there) rather than its actual purpose: to lower the risk of birth defects. That made me a bit curious about how many women take it, and I was shocked to find how few it is (fewer than a third): www.theguardian.com/uk-news/2014/feb/19/folic-acid-less-third-pre-pregnancy-guidelines-spina-bifida. The worst part, I think, is this:
The study also showed strong ethnic variations, with only 17% of Afro-Caribbean women, 20% of south Asian women and 25% of east Asian women taking folic acid, compared with 35% of white Caucasian women.

Just 6% of teenagers under 20 attending the antenatal clinics had taken the supplements, while 40% of older women aged 35 to 39 followed the guidelines.

Presumably a large part of that with the teenagers is the likelihood that their pregnancies were unplanned, but the health inequality here is really awful - it shouldn't be the case that some women and babies are so much more at risk of suffering these problems than others, whether through a lack of knowledge or through being less likely to plan their pregnancies.

I think we could do with a stepped-up public campaign on folic acid, but that obviously doesn't help women with unplanned pregnancies, and realistically no campaign is ever going to get across to everyone.

To me the argument for putting folic acid in flour, as they do in the US, is incredibly clear-cut. And yet the government decided against this: www.ifglobal.org/en/37-temp-news/4768-uk-government-says-no-to-mandatory-fortification-of-flour-with-folic-acid-2. So - and this is a genuine question - am I missing something? What's the argument against?

I take it (when I can remember) as ttc, but I do so because of my age and b) to try and reduce the risk of birth defects and being a potential older mother, I am very aware of.

From what I've read the risk isn't that folic acid causes B12 deficiency, but that it could mask it, so it doesn't show on tests (and so isn't treated) - and that can be resolved by using different tests. However, I'm happy to be corrected on that.

mike it isn't that folic acid causes b12 deficiency, it's that it covers up the symptoms but not the damage that it does so instead of being diagnosed you don't notice your body is being affected.

I take a B vit supplement because of folate deficency (sp) and absorbstion issues so im not taking to much of 1 and not another iyswim

And the babies of unplanned pregnancies?

Are you proposing everyone is banned from, say, drinking alcohol in case they become pregnant?

Are you proposing everyone is banned from, say, drinking alcohol in case they become pregnant?

Absolutely not. But that's nothing like adding a supplement which the BMA says is safe and will have a measurable benefit to food.

There is currently a Cochrane review of folic acid fortification of flour ongoing (see here. So that is pretty good evidence that the evidence is NOT currently clear cut at all - if it was, the Cochrane collaboration would not be spending time on the issue. Doesn't say when they hope to publish (a Cochrane review is a big big job) but that will be a massive help to UK government or any other policy makers, if they are going to revisit the issue.

Interestingly in the above protocol when they discuss adverse effects, they cite an article saying that higher folate levels may cause defects in pregnancy if the woman has B12 deficiency.

I think surely even the OP can't say it's a policy that has no down sides at all?!

Are you proposing everyone is banned from, say, drinking alcohol in case they become pregnant?

Absolutely not. But that's nothing like adding a supplement which the BMA says is safe and will have a measurable benefit to food.

So, you don't actually care about the health of uplanned babies. You need to come up with a better line than "what about unplanned pregnancies"

You can't protect every single person, born or unborn. People have to take responsibility for themselves, I don't believe what amounts to a nanny state is the answer.

"all women of child bearing age should take folic acid ..."

The Handmaid's Tale calls!

I think surely even the OP can't say it's a policy that has no down sides at all?!

Well, that's exactly why I started the thread: because I couldn't see any. A couple of people have raised issues such as the B12 deficiency detection that I didn't know about and so I've learnt from the thread. To me the case still strong that we should do this, but I am genuinely open to (and interested in) counter-views.

People do need to be partly responsible for their own unplanned pregnancies. Adding additives 'just in case' someone gets pregnant at the possible risk of someone else's health should not really be an option.

Clearly, more research and definitive answers needed.

Oh for goodness saķe as soonas some mumsnetter spouts the handmaids tale all conversation ends for me. Sorry

So, you don't actually care about the health of uplanned babies

Yes I do, but I think it has to be balanced against other considerations. I think that undermining women's autonomy is too big a price to pay for better infant health, but that fortification of flour might be an appropriate intervention. The choices aren't 'do nothing' or 'do absolutely everything'. In the same way I wouldn't ban high-salt foods, but I think the fact that manufacturers have been reducing salt in processed food is a good thing that has had measurable benefits for public health.

It is currently under debate whether flour should remain fortified.

There is a moderately interesting article in the Independent as to whether mass medication through food fortification should take place - www.independent.co.uk/life-style/food-and-drink/features/should-we-be-fortifying-foods-with-nutrients-6348759.html

Clearly, more research and definitive answers needed.

Absolutely - great news about the Cochrane report that was posted upthread. However, I now suspect that even if the evidence is strongly in favour then there might be strong opposition.

Mrs Jayy:

Well whenever a poster talks about all women as incubators-in-waiting, that's what I think of.

When will women be seen as individuals rather than as collectively owned mummies-to-be/ guardians of the continuation of the species?

I think the fact that manufacturers have been reducing salt in processed food is a good thing that has had measurable benefits for public health

Yes, that is a reduction in a harmful addition to food products, not introducing yet another to what should be an unadulterated product for anyone to choose for consumption.

Well whenever a poster talks about all women as incubators-in-waiting, that's what I think of

I'm genuinely not sure whether this is aimed at me - if so, then I absolutely don't think all women are incubators-in-waiting, and I think one of the advantages of a fortification of food is that it doesn't require women of child-bearing age specifically to change their behaviour, which I agree is a problematic idea.

When will women be seen as individuals rather than as collectively owned mummies-to-be/ guardians of the continuation of the species?

This ^^ I couldn't agree with you more DC

So, you don't actually care about the health of uplanned babies. You need to come up with a better line than "what about unplanned pregnancies"

Out of interest - what do you think is my secret conspiracy, if I don't actually think this is a good idea because it would have a positive health impact?

Lisa, it was directed towards the PP who wrote: "all women of child bearing age should take folic acid ..."

As if women are a herd of brood mares or something.

I ate folic-rich foods and took supplements when planning and during early stages of my pregnancy. It really wasn't problematic at all. Now I don't need to take supplements, so would be very cross were a supplement unnecessary to my dietary requirements be added to my food, a supposedly raw ingredient, that I choose to buy to make my own cakes/pastry. I don't want folic acid added to it, as it may interfere with my health in other ways.

That would be problematic.

Announcing that "all women of childbearing age should take folic acid", as at least 2 contributors have done on this thread, is treating women like incubators-in-waiting.

I don't think it reasonable to medicate the population, with the risks associated, for the benefit to such a small proportion of it (women who are less than 3 months before or after conception and folic acid deficient).

I think people have to allow others to make their own decisions.