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Similar policies already exist in around 80 countries worldwide. Folic acid is the man-made form of the vitamin, folate. This vitamin is important for cell division in general and, with vitamin B12, the production of healthy red blood cells. Deficiency results in a type of anaemia. It is found naturally in some foods such as leafy green veg and is currently added voluntarily to others such as breakfast cereals. A healthy diet can usually deliver sufficient but a higher intake is required during the first 12 weeks of pregnancy when the baby’s neural tube, which becomes the spine and brain, is forming. 

Folate intake and blood folate levels (‘status’) have both worsened over the past decade, with the proportion of women of childbearing age with a red blood cell folate concentration below the threshold signalling an increased risk that a pregnancy may be affected by a neural tube defect (NTD) increasing from around two-thirds to almost 90%. Furthermore, status has worsened across the population in general, including adolescents (average intake in adolescent girls is now below the reference level known as the RNI).

Folic acid supplements during early pregnancy help reduce life-threatening NTDs in the baby, such as spina bifida. Women of childbearing age are advised to routinely take a daily 400µg supplement because around half of pregnancies are unplanned and the vitamin is needed in the very early stages of pregnancy. But uptake is low, especially in those on low income (consumed by only 10% of women in the most deprived decile compared to 26% in least deprived) and in those under age 20. 

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