From December 2026, millers and flour producers in the UK will be required by law to fortify non-wholemeal wheat flour with folic acid. The move comes as new data shows a decline in the number of women taking the supplement before pregnancy, raising concerns about preventable birth defects.
A commentary published in the journal BJOG: An International Journal Of Obstetrics And Gynaecology reports that fewer than one in five women in England took folic acid before becoming pregnant in 2024/25. The figure has declined steadily from 2021/22, when 26.2% of women took the supplement before pregnancy. The decline was observed in all regions of England apart from London.
Why Folic Acid Matters
The NHS advises women who are trying to get pregnant to take 400 micrograms of folic acid every day. Ideally, women trying to conceive take the supplement for three months before getting pregnant and for the first 12 weeks of pregnancy.
Folic acid helps a baby's brain, skull and spinal cord develop and reduces the risk of neural tube defects such as spina bifida, as well as other conditions. Researchers from the University of Southampton warned that the decline in use of the vitamin before pregnancy is undermining progress in preventing serious birth defects.
Fortification 'Part of the Solution'
While the fortification of flour has been welcomed, experts have said it will not be enough on its own and should not replace supplements for women planning a pregnancy. The authors of the paper have called for renewed public health campaigns highlighting the benefits of the supplement and rebuttal of misinformation online.
Lead author Dr Danielle Schoenaker, NIHR advanced fellow at the University of Southampton and NIHR Biomedical Research Centre: Southampton, 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."
She added: "It is therefore worrying to see the number of women taking supplements before pregnancy continuing to fall. Many people do not realise that the baby's brain and spinal cord begin developing very early in pregnancy, often before a pregnancy has been confirmed. This means that waiting until after a positive pregnancy test can be too late to gain the full protective benefits of folic acid."
Dr Schoenaker described the planned fortification of flour as "an important and positive development, but it should be seen as part of the solution rather than the complete answer." She said women planning a pregnancy will still need clear advice and support to take folic acid supplements.
Need for a Joined-Up Approach
Co-author Professor Keith Godfrey, from the University of Southampton and NIHR Biomedical Research Centre: Southampton, said: "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."
He added: "By helping more women to take folic acid before pregnancy, we have an opportunity to reduce preventable health problems and give more children the best possible start in life."
Lia Brigante, professional policy adviser at the Royal College of Midwives, said: "The fact that fewer than one in five women are now taking folic acid before pregnancy shows how many are never offered this information in time. Most women have no contact with a midwife until their booking appointment, at 10 to 12 weeks, long after folic acid has done most of its work."
She added: "Everyone should have clear advice available before and all the way through pregnancy. With the right investment in the NHS workforce, every woman could be offered preconception advice as standard, rather than it being left to chance."
Brigante noted that uptake is lowest among women in the most deprived communities, and said fortifying flour will help reach women who would otherwise miss out, but it is no substitute for a properly resourced system that gives every woman the support to decide what is right for her.
