European folic acid policies are not effective enough

The prevalence of neural tube defects in Europe has not declined substantially in the past decade, despite national policies of folic acid supplementation in half the countries, finds a study in this week's BMJ.

Each year, more than 4500 pregnancies in the European Union are affected by neural tube defects.

Researchers examined trends in the prevalence of neural tube defects in 16 European countries between 1980 and 2001, according to their folic acid policies during that time.

They found no substantial decline in neural tube defect rates in Continental Europe in the past decade, and although levels in the United Kingdom and Ireland fell by 32% (a continuation of a long-standing decline) they remain higher than levels in Continental Europe.

These data suggest that policies recommending supplementation of folic acid before conception and during early pregnancy in planned pregnancies are not effective enough, say the authors.

They explain that many women may not receive or respond to health promotion messages stressing the need to commence supplementation before conception, or may remain unaware that changes in diet are unlikely to achieve sufficient folate intake, and a large proportion of pregnancies in most countries are unplanned.

Folate status of most women of childbearing age could be raised by fortifying a staple food with folic acid, which would also help to reduce socioeconomic inequalities in the prevalence of neural tube defects, they write.

The potential for preventing neural tube defects in Europe by raising folate status is still far from being fulfilled, and it is unacceptable to continue to rely mainly on prenatal screening and termination to reduce the number of babies born with neural tube defects, they conclude.

Contact:
Araceli Busby, Lecturer in Environmental Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
Tel: +44 (0)20 7927 2442
Email: [email protected]

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