In the UK expectant mothers are currently prescribed and recommended to take folate supplements to reduce the risk of neural tube defects. However, a recent study (British Medical Journal, Vol 330, pp 571) reported that the advice did not result in women actually taking the supplements.
Chris Whitehouse, a lobbyist with the Whitehouse Consultancy, represented Consumers for Health Choice (CHC) at talks with the Food Standards Agency and said: "What was clear is that the benefit of folate consumption in addressing the problem of neural tube defects is now universally accepted."
Whitehouse now predicts that it is now a question of 'when' and not 'if' the UK government will introduce compulsory fortification of some flour products with folic acid.
Although CHC is opposed to mandatory fortification, Whitehouse said that the FSA has conducted "an open-minded, professional, transparent, and genuinely inclusive consultation exercise."
Last November the Scientific Advisory Committee on Nutrition, a group of independent experts that advises the UK's food authorities and health department, recommended to the government that folic acid fortification be made compulsory, along with a strategy to manage vitamin B12 deficiencies in the over-65s.
In 1998 the US introduced similar measures; a move that has seen the number of birth defects fall by 25 per cent. Similar strategies in Canada have seen the instance of birth defects cut in half.
Since bread is a staple in most diets, flour has been seen as the ideal vehicle to improve folate intake for a population. Studies have shown that folic acid is more easily absorbed from fortified foods (85 per cent) and supplements (100 per cent) than the folate found naturally in foods (50 per cent).
According to a new report from American voluntary health agency March of Dimes, eight million babies are born with defects every year, equivalent to about six per cent of all births worldwide.
One of the most common birth problems identified was neural tube defects such as spina bifida and anencephaly - most of which could be avoided if mothers were eating more folate-rich foods or taking supplements.
Dr Jennifer Howse, March of Dimes president, said: "Our report identifies for the first time the severe, and previously hidden global toll of birth defects. This is a serious, vastly unappreciated and under-funded public health problem."
The report also highlighted the gulf between the richer and poorer nations.
France has the lowest rate with birth defects affecting only 3.97 per cent of newborns. Spain and Italy are also listed in the top ten. The highest rate of birth defects was measured in Sudan with 8.2 per cent.
Less than 250 000 babies are born in Europe with inherited birth defects, a figure that could be reduced further if mothers ate more of a Mediterranean-type diet, a rich source of olive oil, fruit and vegetables, or increased their folate intake.
The Mediterranean diet, rich in folates from its high leafy vegetable content, has previously been credited with longer life and improving heart health. The new report now indicates that the diet may also prevent against birth defects.
The US fortification program has not been a total success story however with a commentary published in the journal Pediatrics (Sept. 2005, Vol. 116, pp.753-755) echoing March of Dimes claims that more needs to be done.
Authors Robert Brent and Godfrey Oakley wrote, "It is a tragic failure of public policy, both in the United States and around the world, that a single case of folic acid-preventable spina bifida and anencephaly occurs."
Campaigners have advocated upping the fortification level in the US, currently at 140 micrograms of folic acid per 100 grams of grain.
Those opposed to mandatory fortification argue that there could be possible side-effects. An investigation into flour fortification in the UK in 2002 raised concerns that such a move could mask a deficiency of vitamin B12 in elderly people.
Folic acid can remedy anaemia caused by a lack of B12 but this threatens to delay treatment for the underlying B12 deficiency, which can cause neurological damage.