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It sounds simple. Taking supplements of folic acid before conception and in early pregnancy can massively reduce the risk of a fetus developing a neural tube defect (NTD) – when the spinal cord or brain doesn’t develop properly – that can result in spina bifida or anencephaly.
And yet, advising women who might become pregnant to do this hasn’t been effective at reducing NTDs in the UK and Europe; supplements probably need to be taken before conception to be effective and not all pregnancies are planned. Fortunately, there is another approach that works.
Most flour, and hence bread, in the US and Canada has been fortified with folic acid, also known as vitamin B9, since 1998. This was followed by an immediate fall in NTD cases; for example, in Canada rates halved between 1996 and