Women of childbearing age in Ireland need to consume higher levels of folic acid in order to reduce the incidence of severe birth defects here, a new report has found.

The scientific report has been published by the Food Safety Authority of Ireland (FSAI) and it provides a detailed update on folic acid (folate) and its role in reducing rates of neural tube defects (NTDs), which are birth defects of the brain, spine or spinal cord. Spina bifida is the most common NTD.

Ireland currently has one of the highest rates of NTDs in the world. Taking folic acid before conception and during the early stages of pregnancy has been proven to prevent up to 70% of these defects.

However, just 36% of Irish women of childbearing age have blood folate levels which would be considered adequate to provide optimal protection against NTDs.

Furthermore, one in five young women consume no folic acid at all, i.e. folic acid supplements or fortified foods, therefore very few of these would have the blood folate level required to help protect their babies from NTDs should they become pregnant.

Since the early 1990s, the policy in Ireland has been to advise all women of childbearing age to take 400 micrograms of folic acid every day as a supplement, whether they are planning to become pregnant or not. However, it is widely acknowledged that many women do not do this and there is a major concern that those from disadvantaged areas are the least likely to follow this recommendation.

Since the early 1980s, some foods have been fortified with folic acid by manufacturers and this has helped to reduce the risk of NTD pregnancies in Ireland. However, this is voluntarily done by manufacturers and has been shown to be less effective than mandatory fortification schemes in countries such as the US, which has a much lower rate of NTDs than Ireland.

The FSAI report provides two options and it proposes that one of these options should be implemented in Ireland to reduce the risk of NTDs:

-Mandatory fortification with voluntary fortification and advice on supplementation: The mandatory fortification of bread or flour in Ireland would provide about 150 micrograms of folic acid per day in women of childbearing age. This could reduce the prevalence of NTDs by around 30%. This would require legislation. This should be accompanied by advice to all women of childbearing age who are capable of becoming pregnant to take an additional 400 micrograms of folic acid daily as a supplement. Voluntary fortification of foods with folic acid would continue

-Voluntary fortification with advice on supplementation: A continuation of the current policy to advise all women of childbearing age who are capable of becoming pregnant to take an additional 400 micrograms of folic acid every day as a supplement. Voluntary fortification of foods with folic acid would continue.

The FSAI noted that compared to the first option, the second option ‘has weaker evidence to support its possible effectiveness in further reducing rates of NTD-affected pregnancies from the current rate'.

"There is conclusive scientific evidence linking low levels of folate with spina bifida and related birth defects, and this is a major challenge given the low levels of folic acid in the Irish diet which needs to be addressed," commented Dr Mary Flynn, the FSAI's chief specialist in public health nutrition.

She emphasised that ‘most women'' in the target group are not following the advice of taking a 400 microgram supplement every day.

"This is a particular concern given the link with birth defects. Ongoing and sustained information campaigns are therefore required to promote the use of folic acid supplements as part of a national strategy to reduce birth defects," she added.