Correspondence

Folic acid supplementation: advice to health professionals from the UK chief medical officers, chief nursing officers and chief midwifery officers

Published 27 November 2024

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In September 2021, the 4 UK governments announced the intention to mandate the fortification of non-wholemeal wheat flour with folic acid on a UK-wide basis to reduce the number of neural tube defects (NTDs) in foetuses.

This policy change is being implemented as part of the review of the Bread and Flour Regulations 1998 (BFR), led by the:

  • Department for Environment, Food and Rural Affairs (Defra, England)
  • Food Standards Agency (FSA, Wales and Northern Ireland)
  • Food Standards Scotland (FSS)

Legislation was laid in England on 14 November 2024 (the Bread and Flour (Amendment) (England) Regulations 2024), with equivalent legislation to be laid shortly in Scotland, Northern Ireland and Wales. Industry has a 24-month transition period to fully implement the changes, by December 2026.

Currently, guidelines recommend that women who could become pregnant take a daily supplement of 400 micrograms of folic acid before conception and up until the 12th week of pregnancy to reduce the risk of NTD-affected pregnancies. This advice will continue following the fortification of flour with folic acid. Fortification of flour with folic acid is intended as a population measure to support, not replace, current supplementation advice for individuals.

There is a risk that some women will stop taking folic acid supplementation following fortification of flour, incorrectly assuming that it is no longer required. To mitigate this we, the chief medical officers, chief nursing officers and chief midwifery officers for the UK, are writing to you as health professionals to ask that you continue to promote the importance of folic acid supplementation directly to women of child-bearing age through existing communication channels, including face to face interactions.

Thank you for your ongoing efforts to advise on and promote this important supplementation to women of child-bearing potential in order to reduce the risk of NTDs in foetuses. Please disseminate this advice to relevant colleagues, particularly those who are patient facing.

For further information, see:

Professor Sir Chris Whitty, Chief Medical Officer for England
Professor Sir Gregor Smith, Chief Medical Officer for Scotland
Professor Sir Michael McBride, Chief Medical Officer for Northern Ireland
Professor Sir Frank Atherton, Chief Medical Officer for Wales
Duncan Burton, Chief Nursing Officer for England
Anne Armstong, Interim Chief Nursing Officer for Scotland
Maria McIlgorm, Chief Nursing Officer for Northern Ireland
Sue Tranka, Chief Nursing Officer for Wales
Kate Brintworth, Chief Midwifery Officer for England
Justine Craig, Chief Midwifery Officer for Scotland
Caroline Keown, Chief Midwifery Officer for Northern Ireland
Karen Jewell, Chief Midwifery Officer for Wales

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