Encouraging pregnant women to take folic acid has not led to a reduction in neural tube defects in Europe, researchers say today.
Researchers called on European governments to consider mandatory fortification of food to ensure women get the vitamin before and during pregnancy.
Many European countries have long-standing recommendations for women to take folic acid supplements if planning a pregnancy, in order to prevent neural tube defects – a major group of severe congenital anomalies linked with substantial mortality, morbidity, and long term disability.
A team led by Dr Babak Khoshnood at INSERM, Paris, France, used figures on 11,353 cases of neural tube defects, including 5,776 cases of spina bifida, from 28 registries in 19 European countries covering about 12.5 million births between 1991 and 2011.
The overall rate of neural tube defects during the study period was 9.1 per 10,000 births.
It "fluctuated slightly but without an obvious downward trend", reports the team in The BMJ.
"In the absence of mandatory fortification, the prevalence of neural tube defects has not decreased in Europe despite longstanding recommendations aimed at promoting peri-conceptional folic acid supplementation and existence of voluntary folic acid fortification," say the team.
They conclude that Europe has failed to implement an effective policy for prevention of neural tube defects by folic acid.
Mandatory fortification of food staples with folic acid "should be considered as an important and more effective means for prevention of neural tube defects, while weighing the evidence for its proven benefits and possible risks", they believe.
This approach has been shown to work in many countries including the US, they add.
The Royal College of Obstetricians and Gynaecologists backed the call for fortification of food.
Professor Alan Cameron, from the college, said: “Food fortification will reach women most at risk due to poor dietary habits or socioeconomic status as well as those women who may not have planned their pregnancy.
“Folic acid supplementation before pregnancy has been shown to reduce the number of pregnancies affected by neural tube defects, such as spina bifida."
Khoshnood, B. et al. Long term trends in prevalence of neural tube defects in Europe: population based study. BMJ 25 November 2015; doi: 10.1136/bmj.h5949 [abstract]
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