Folic acid added to flour has been preventing anencephaly and spina bifida in Australian babies - saving lives and curbing costly, dangerous birth defects - since 2009, and scientists are demanding the same in New Zealand.
A new report co-authored by former chief science adviser Sir Peter Gluckman and the Royal Society Te Aparangi, and commissioned by the Ministry of Health was released on Friday, and found folic acid fortification in bread is definitely linked to lower rates of birth defects.
Capital and Coast District Health Board paediatrician Andrew Marshall says it’s an effect that’s been known about for years.
“This is a fantastic report but it produces just the same evidence as we had in 2006, 2007,” Dr Marshall says.
“Eighty countries in the world do this, and the science - as the report reiterates - is very convincing about the safety and the efficacy.
He says the effects are dramatic.
“Probably about half neural tube defects are folate responsive … so we’ll never completely eliminate anencephaly and spina bifida but we can get those rates down to a minimum.”
Three main groups are affected by neural tube defects: families who abort a fetus that has anencephaly or spina bifida, babies born with anencephaly who usually die within days of being born, and babies born with spina bifida who have a range of health problems during their childhood.
“They have an average of about 18 operations by the time that they’re 18, frequent urinary tract infections, bladder and bowel control issues, difficulty walking, needing a range of education therapies and physio and occupational therapies.”
There are between five and 15 neural tube defect-affected pregnancies in New Zealand a year, Dr Marshall says, and if mandatory bread fortification had been brought in there would have been about 90-100 pregnancies with a different outcome since 2009.
He says New Zealand and Australia both moved to mandate adding folic acid to bread after the reports in 2006 and 2007.
“But the government of the day pulled back from that in 2009 and then completely in 2012 and we’ve had a voluntary regime since then.”
He says a voluntary regime and recommendations to mothers will never work, “because 40 percent of pregnancies are unplanned.
“By the time you know you’re pregnant actually the neural tube is already formed, so you have to take folic acid before you’re pregnant.”
It was likely bread industry lobbyists that stopped the government from regulating bread fortification.
“Effectively it was not progressed at the time and it was mainly around the industry - the bread-making industry - not wishing to have a mandatory regime,” Dr Marshall says.
He says Australia did not pull back from regulation when New Zealand did, and there was no public pushback there because they legislated for folic acid addition to flour, not bread.
“There are only two or three flour mills [in Australia] and so it’s a very simple process. Here [in New Zealand] we’re talking about hundreds of community bakeries and things adding folic acid to their product.
“A 2016 report in Australia has shown the benefits of reducing neural tube defects.”
The recommended dose of fortified bread is calculated as about a couple of slices per day, plus the folic acid already in several breakfast cereals and natural folate in green leafy vegetables.