New UK legislation mandates fortifying flour with folic acid to protect newborns

By the end of 2026, millers and flour producers must fortify non-wholemeal wheat flour with folic acid to protect newborn babies from severe brain and spine problems.

The UK government estimates that the move will prevent around 200 cases annually of neural tube defects in a developing fetus and improve the health of pregnant women. The neurological disorder also has significant human and financial costs for affected babies and their families.

Over ten years, the government estimates the legislation will deliver savings of around £20 million (US$25.3 million) to the National Health Service (NHS) and boost the economy by more than £90 million (US$113.7 million).

Researchers and experts welcome the move, highlighting its benefits for pregnant women, infants and the general population. However, others state the legislation is limited, as it excludes wholemeal flour and rice. 

“Shifting care from sickness to prevention is one of the leading ambitions in our 10 Year Health Plan as we work to make our NHS fit for the future. These measures are a simple and effective intervention to improve health outcomes in babies, giving them the best start in life,” says Andrew Gwynne, minister for Public Health and Prevention.

Manufacturers have a 24-month transition period to adjust their processes. 

Focus on prevention

The NHS recommends women who are trying to have a baby take folic acid supplements for three months before getting pregnant and at least 12 weeks after becoming pregnant. Although this recommendation will remain in place, the government asserts it will help provide women with a higher baseline intake, especially since half of pregnancies in the country are unplanned. 

In addition to NHS savings, the UK government predicts an additional £571 million (US$721.1 million) in benefits to society through an increase in live births, £54 million (US$68.2 million) due to increased labor market participation and another £39 million (US$49.3 million) due to parents prevented from leaving the labor market.

The new legislation comes after years of campaigning and several reviews of fortification with folic acid by the Scientific Advisory Committee on Nutrition (SACN). 

“SACN welcomes this important initiative, which will reduce the number of lives adversely affected by neural tube defects. SACN has consistently recommended folic acid fortification since 2006, alongside ongoing monitoring and continued encouragement for women to take folic acid supplements before pregnancy,” comments professor Ian Young, SACN chair.

UK experts note more could be done to prevent neural tube defects if wholemeal wheat flour and rice were also fortified with folic acid.Joe Brennan, head of technical and regulatory affairs at UK Flour Millers, adds the UK flour milling sector has also been working with the government to facilitate the initiative for several years. 

“Flour remains one of the most widely consumed ingredients, so there is a logic to fortifying flour with folic acid, supported by public health experts. Folic acid will join other fortificants, including vitamins and minerals, added to flour since the 1940s, in line with government bread and flour regulations.” 

Similarly, Dutch food ingredient expert Corbion is developing folic acid-fortified corn tortillas to help reduce neural tube defects. The company notes that despite the US FDA’s approval of fortifying corn masa flour with folic acid, only 14% of corn masa flour products in 2023 contained the nutrient.

Insufficient scope

At the same time, UK experts note that more could be done to prevent additional neural tube defects if all flour and rice were fortified. 

Neena Modi, a professor of Neonatal Medicine at Imperial College London, notes that folic acid supplementation was shown in a 1991 study to reduce neural tube defects by about 80%.

“However, this news is tempered by the decision to restrict fortification to non-wholemeal flour only, as this will disadvantage groups such as women who are sensitive to gluten, eat rice in preference to bread and products made from wholemeal flour, excluding them and their babies from benefiting, and thus add to the considerable health inequities that already exist in the UK.”

Similarly, Dr. Jonathan Sher, former deputy director of the Queen’s Nursing Institute Scotland, says the path is “timid, unscientific and will predictably fail to prevent most of the harm currently caused by neural tube defects.” 

“Much too large a number of miscarriages, stillbirths, therapeutic terminations, birth defects and other preventable problems will continue to happen by avoiding fully effective fortification,” he cautions.

In an interview with Nutrition Insight, the Food Fortification Initiative underscored the need for increased food fortification globally to help reduce micronutrient deficiencies. For example, the initiative highlighted that a wheat flour fortification program in India significantly improved people’s iron, folate and vitamin B12 status.