The best of both worlds
Combining folic acid fortification and supplementation for healthier babies
Scientists worldwide agree that mothers-to-be should consume 600-800mcg of folate daily both before conception and during early pregnancy.
It is recommended they obtain this through foods that contain folate naturally as well as by consuming folic acid, the form of folate that is added to fortified foods and food supplements.
In doing so, they will significantly lower the risk of giving birth to a baby with an abnormality to the brain or spine – known as a neural tube defect (NTD).
For this reason, women who are planning to become pregnant are advised to ensure their intake of folic acid is adequate.
Born and bread
However, a large proportion of pregnancies are unplanned – the figure is as high as 50% in the USA. 1
In response, many countries have put in place programmes to fortify everyday foods with folic acid – often bread, maize or rice, because they are so widely consumed.
Fortification programs such as these are seen as key to ensuring that all women of child-bearing age have enough folic acid in their diet – just in case they become pregnant unexpectedly.
Keeping NTDs in check
Fortification’s impact has been positive and rates of NTDs are lower today than they were in the past.
But more needs to be done. Globally, there are still 18.6 NTD births per 10,000 livebirths. 2
However, the picture varies considerably, with rates in some parts of the world significantly lower than in others.
In South Asia the figure is as high as 31.2 per 10,000 livebirths. By contrast, across Latin America and the Caribbean there are 8.6.
In the USA, the figure is lower still. In fact, the evidence from here suggests that a dual strategy of fortifying food and taking food supplements that contain folic acid represents the most effective way to keep NTDs in check.
An American
success story
The US has shown how it’s possible to lower NTD rates with a two-pronged approach.
It has an extensive mandatory folic acid fortification program, covering bread, cereals, flour, corn meal, pasta, rice and other grain products.
Meanwhile, the Centers for Disease Control & Protection – a US government body – recommends that all women of reproductive age obtain 400mcg of folic acid a day from food supplements to help prevent NTDs.
That’s in addition to the folic acid they consume in fortified foods and the folate they get from a varied diet. 3
As a result, America now has one of the lowest NTD birth rates in the world – just 5 per 10,000 livebirths.  4
Growing consensus
Scientific evidence shows beyond doubt that consuming folic acid at adequate levels helps to lower the risk of NTDs.
There is also a growing consensus that food supplements have a key role to play in ensuring that women of child-bearing age achieve a daily folic acid intake that is sufficiently high.
The World Health Organization, for example, recognizes the benefits of taking a folic acid supplement daily to prevent NTDs: 5
"All women, from the moment they begin trying to conceive until 12 weeks of gestation, should take a folic acid supplement (400mcg folic acid daily)"
Perfect delivery
It’s clear there is widespread agreement supporting the benefits of folic acid food supplements for women who are capable of becoming pregnant.
And yet approximately 260,000 pregnancies are still affected by NTDs every year. 6
The majority of these are preventable with folic acid.
A combined strategy of fortification and the use of food supplements has been shown to be the most effective way to deliver folic acid at the levels needed to effect change.
It’s an approach that offers mothers-to-be the best of both worlds and their babies the best start in life.