Use of a key vitamin to protect children before pregnancy has fallen among women in England in the last decade, researchers warn today.
The slump in use of folic acid led to experts calling for compulsory fortification of flour with folic acid.
Mothers under 20 and women from ethnic minority backgrounds are among those least likely to take the vitamin supplement.
Folic acid is known to prevent spina bifida and other birth defects of the brain and spine.
Women who may become pregnant have been advised to take it for more than 20 years.
But the new research shows that at the turn of the century some 35% of mothers had taken it before pregnancy – while this decade just 31% of pregnant women have taken it.
In contrast, researchers found a big increase in the number of women taking the supplement during pregnancy – from 45% to 62%.
The findings come from a study of nearly half a million women taking part in antenatal screening in England and the Isle of Man between 1999 and 2012.
Researcher Professor Joan Morris, of Queen Mary, University of London, said: "Each year in Britain there are about 1,000 pregnancies affected by spina bifida or other birth defects of the brain, spine, or spinal cord.
"Most of these lead to a termination of pregnancy which is an agonising decision for couples who want a child."
Fellow researcher Professor Sir Nicholas Wald said: "It’s a public health tragedy that in spite of the folic acid fortification initiative in many countries, the UK has not introduced mandatory folic acid fortification.
"The failure to fortify flour with folic acid is like having a polio vaccine and not using it."
The Royal College of Midwives said some women would be unable to afford to take supplements routinely.
Jane Munro, from the college, said: "There is a need to ensure access to supplements for women who are unable to afford them, and to reach groups of women where taking these supplements is low."
She warned against rushing in flour fortification measures.
She said: "On the issue of adding folic acid to foodstuffs such as flour, we would stress the need for more discussion before such a step is taken, because there will be people for whom additives will be unacceptable."
PLoS ONE 20 February 2014 [abstract]
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