Fewer than one in five women in England are taking folic acid before pregnancy, a decline that experts warn is undermining progress in preventing serious birth defects. New advice is set to change in 2026, when fortification of flour becomes mandatory.
Decline in supplement use
According to a commentary in the journal BJOG, only 19.8% of women in England took folic acid before becoming pregnant in 2024/25, down from 26.2% in 2021/22. The decline is seen in all regions except London.
Women trying to conceive are advised by the NHS to take 400 micrograms of folic acid daily, ideally for three months before pregnancy and for the first 12 weeks of pregnancy.
Importance of folic acid
Folic acid helps a baby's brain, skull, and spinal cord develop, reducing the risk of neural tube defects like spina bifida. Researchers from the University of Southampton highlighted the worrying trend.
By the end of 2026, millers and flour producers will be required by law to fortify non-wholemeal wheat flour with folic acid. Experts say fortification alone is not enough and should not replace supplements for those planning a pregnancy.
Calls for action
The authors call for renewed public health campaigns and rebuttal of online misinformation. Lead author Dr Danielle Schoenaker said: "Taking folic acid before pregnancy is one of the simplest and most effective steps women can take to support a healthy start for their baby."
Co-author Professor Keith Godfrey added: "We need a joined-up approach – this should combine effective fortification at higher levels than mandated in the UK with better education, accessible preconception care and targeted support for communities where supplement use remains low."
Lia Brigante of the Royal College of Midwives noted that most women have no contact with a midwife until 10 to 12 weeks, long after folic acid has done most of its work, and called for investment in the NHS workforce to offer preconception advice as standard.
