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RCOG response to new study into folic acid fortification

News 31 January 2018

There are fresh calls for the government to fortify flour with folic acid in the UK to help protect babies from common birth defects after a new study found there is no need for an upper limit of folate intake. 

The study, by Queen Mary University of London and the School of Advanced Study, University London, shows that the maximum suggested intake of folate (1mg/day) is based on 'flawed' analysis. 

Commenting in response, Mark Kilby, Professor of Fetal Medicine and spokesperson for the Royal College of Obstetricians and Gynaecologists (RCOG), said:

“We welcome this important study which recommends there should be no upper limit of intake for folate. This should help to remove any final barriers to folic acid fortification of foods such as flour.

“There is clear evidence that fortification will prevent approximately half of all neural tube defects, such as anencephaly and spina bifida. There are around 1,000 diagnoses of neutral tube defects in utero in the UK, 85% of which result in an abortion. This accounts for around 1 in 200 abortions in the UK, many of which will be in the second trimester of pregnancy. In addition, a recent systematic review has demonstrated that periconceptual folic acid supplementation will reduce the risk of a baby being born small for gestational age, and therefore the theoretical risk of stillbirth.

“The authors of this paper challenge the old assumption that high levels of folic acid are toxic and may mask the neurological effects of vitamin B12 deficiency by re-analysing the evidence and demonstrating no relationship between the dose of folic acid and the development of neurological morbidity. 

 “The RCOG has long supported fortification of flour with folic acid as a public health measure to prevent neural tube defects in babies. This simple measure will reach women most at risk in our society who have poor dietary and socioeconomic status, as well as those women who may not have planned their pregnancy. We continue to recommend that all women take 400 micrograms of folic acid daily whilst attempting to conceive, until their 12th week of pregnancy.

 “If the UK government decided to add folic acid to flour it would prevent countless family tragedies. Governments in Scotland and Wales are already united in calling for this important change.”


 1. Hodgetts VA et al. BJOG. 2015;122(4):478-90. 

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