Folic acid will be added to UK flour from December. Here’s why

Fewer than one in five women in England now take folic acid before pregnancy . This is down from one in four just five years ago.

The decline is worrying because it could undermine the progress that has been made in recent years to prevent serious birth defects linked to low folic acid intake.

Although the UK government has mandated that from December 2026 all non-wholemeal wheat flour must be fortified with folic acid, the amount being added isn’t enough to stop the ongoing need for folic acid supplements. As such, all women planning to become pregnant should still take a folic acid supplement daily when trying to get pregnant and during their first trimester.

Folic acid is the synthetic form of folate (also known as vitamin B9). It helps cells grow and divide.

In early pregnancy, folic acid supports the development of the neural tube, which becomes the baby’s brain and spinal cord. If the tube does not close properly, babies can develop conditions such as spina bifida or anencephaly.

Spina bifida happens when a baby’s spine and spinal cord do not fully develop, while anencephaly is a severe condition where major parts of the brain and skull are absent.

In England, it’s estimated that some form of neural tube defect occurs in 12.5 per 100,000 births. Most of these conditions can be prevented if a woman has enough folate before becoming pregnant. Other factors, such as not getting enough vitamin B12, may also play a role. Mild forms affect 5 to 10 million people.

Neural tube defects can also lead to pregnancy loss, death soon after birth or lifelong disability, with devastating impacts on families.

Because these conditions develop so early in pregnancy, taking a folic acid supplement before getting pregnant remains one of the most important ways to reduce the risk.

The decline in folic acid use before pregnancy is worrying for a number of reasons.

Uptake is already low in certain groups, with data showing supplement use is consistently lowest among Black and Asian women and those living in deprived areas.

Uptake has also fallen steeply in the north-east of England and remains well below the national average in the west midlands. These differences show folic acid supplement use is not simply individual choice.

Several factors influence uptake. Some women are not planning a pregnancy, while others do not know when folic acid is needed, believe a healthy diet is enough, or lack access to pre-pregnancy care.

Previous pregnancy experience does not necessarily help, either. Research suggests women who have been pregnant before are less likely to take folic acid during their next pregnancy compared to first-time mothers. Possible reasons for this include unplanned later pregnancies, competing childcare responsibilities and a lower sense of need after a prior healthy pregnancy. So knowledge is not enough.