Falling folic acid supplement uptake threatens progress on children's health, experts warn

Declining folic acid supplement use before pregnancy is undermining progress in preventing serious birth defects, say leading health experts.

Recent national data for England shows fewer than one in five women are now taking folic acid before pregnancy.

Southampton researchers warn that the trend could slow progress in reducing preventable birth defects and increase health inequalities unless action is taken.

The experts are all part of the NIHR Inequalities Challenge: Maternity Disparities Consortium.

Their paper has been published today in BJOG: An International Journal of Obstetrics and Gynaecology.

Critical early protection

Folic acid is a form of vitamin B9. It plays a vital role in helping a baby's brain and spinal cord develop during the earliest weeks of pregnancy.

Taking a daily folic acid supplement before pregnancy and during the first 12 weeks of pregnancy can reduce the risk of neural tube defects. These include conditions such as spina bifida.

The challenge is that these defects develop before many women realise they are pregnant. Researchers note that although more women are starting folic acid after their pregnancy is confirmed, this is often too late to provide maximum protection. This is because closure of the neural tube is usually complete by the end of the fourth week after conception.

The new BJOG paper highlights new NHS data. This shows that the proportion of women taking folic acid before pregnancy has fallen from 26% in 2020/21 to below 20% in 2024/25.

Beyond flour fortification

The findings come as the UK prepares to introduce mandatory folic acid fortification of non-wholemeal wheat flour. This will start in December 2026.

While the researchers welcome the move, UK government advice stresses that fortification alone will not provide enough folic acid for everyone. This should not replace supplements for women who are planning a pregnancy.

Dr Danielle Schoenaker is an NIHR Advanced Fellow at the University of Southampton and NIHR Biomedical Research Centre (BRC): Southampton. She was lead author of the commentary.

She 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. 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.

"The planned fortification of flour is an important and positive development. However, it should be seen as part of the solution rather than the complete answer. Women who are planning a pregnancy will still need clear advice and support to take folic acid supplements."

Addressing health inequalities

There are major differences in folic acid use between different communities and regions of England.

Uptake remains lower among women living in more deprived areas and among some ethnic minority groups. London has seen increasing rates of folic acid use. Several other regions have experienced notable declines.

Professor Keith Godfrey, a co-author of the paper from the University and NIHR BRC: Southampton, 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.

"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."

The authors are calling for renewed public health campaigns. These must clearly communicate the benefits while giving a strong rebuttal of misinformation.

They argue that preventing neural tube defects requires both effective food fortification and continued support for women to take supplements before pregnancy.