Folic acid supplementation – advice to health professionals

UK Chief Medical Officers: Folic Acid Supplementation – Continued advice for those who are planning a pregnancy or newly pregnant

Advice to health professionals from UK Chief Medical Officers, UK Chief Nursing Officers and UK Chief Midwifery Officers.

1. Please see the letter from the UK Chief Medical Officers, UK Chief Nursing Officers and UK Chief Midwifery Officers regarding continued folic acid supplementation: In September 2021, the four UK Governments announced the intention to mandate the fortification of non-wholemeal wheat flour with folic acid on a UK-wide basis to reduce the number of Neural Tube Defects (NTDs) in foetuses.
2. This policy change is being implemented as part of the review of the Bread and Flour Regulations (BFR), led by The UK Government Department for Environment Food & Rural Affairs (DEFRA- England), The Food Standards Agency (FSA – Wales and N. Ireland) and Food Standards Scotland (FSS). Legislation was laid in England on 14th November 2024, with equivalent legislation to be laid shortly in Scotland, Northern Ireland and Wales. Industry has a 24-month transition period to fully implement the changes by December 2026.
3. Currently, UK guidelines recommend that women who could become pregnant take a daily supplement of 400 micrograms of folic acid before conception and up until the 12th week of pregnancy to reduce the risk of NTD-affected pregnancies. This advice will continue following the fortification of flour with folic acid. Fortification of flour with folic acid is intended as a population measure to support, not replace, current supplementation advice for individuals.
4. There is a risk that some women will stop taking folic acid supplementation following fortification of flour, incorrectly assuming that it is no longer required. To mitigate this we, the Chief Medical Officers, Chief Nursing Officers and Chief Midwifery Officers for the United Kingdom, are writing to you as health professionals to ask that you continue to promote the importance of folic acid supplementation directly to women of child-bearing age through existing communication channels, including face to face interactions.