Folic acid - the agony of ignorance

EastEnders has come in for a bit of stick with Bianca and Ricky's abnormal baby dilemma but, from what I have seen of it, the observation and dialogue have been superb. "What do we do? Kill this one and keep the next? Keep getting rid of them until a good one comes up? I don't feel we have the right to make a choice." In the end they did, deciding that a child with a combination of spina bifida and hydrocephalus was more than they could cope with. That was a few episodes ago, but their guilt will last the lifetime of the soap.

This isn't helped when a doctor points out that the baby probably would have been healthy if Bianca had taken folic acid supplements before and during pregnancy. Since it wasn't planned, not a single supplement passed Bianca's lips. At present, preventing your baby from having a crippling disease is only an option for those couples who map out their future family on a Psion organiser. And there aren't many of them in Albert Square.

EastEnders has a proud tradition of newsy health storylines (Mark's HIV, Peggy's breast cancer, Jo's schizophrenia) but it has taken them six years to pick up on folic acid. Way back in 1991, the Medical Research Council's Vitamin Study Group announced that the incidence of neural tube defects such as spina bifida could be reduced by 75 per cent if all pregnant women took 400mcg of folic acid each day from three months before conception to the end of the 12th week of pregnancy. It was an amazing discovery that has achieved virtually nothing.

Professional and public awareness remained low and by 1996, a pitiful 9 per cent of women had even heard about folic acid. This spurred the Health Education Authority into a very expensive advertising campaign (remember Zoe Wanamaker and the retreating sperm?). Six months later, a large survey found that although 93 per cent of women had now heard about folic acid and 71 per cent of mothers took it at some stage during pregnancy, only one in 10 took it from well before conception to week 12 - the time needed for it to be effective.

At present, a thousand couples a year suffer the trauma of miscarriages and late terminations and 150 give birth to severely handicapped children, most of whom would have normal spines but for a short course of a cheap, safe, water-soluble vitamin. Health education in itself will continue to achieve nothing whilst 35-50 per cent of pregnancies are unplanned. Even if all women ate more folate-rich green vegetables, the effect would be minimal because naturally occurring folate is hard to absorb from the gut and is destroyed by cooking. In raw form, you'd need to eat six pounds of sprouts a day to absorb the amount needed and you're unlikely to feel like sex afterwards.

In 1996, the US Center for Disease Control recognised that health education and over-the-counter tablets would never deliver a significant reduction in neural tube defects (NTDs), especially since their prevalence is greatest among the young and poor who don't plan pregnancies and are less aware of health issues. American food manufacturers were ordered to add folic acid to flour and a variety of staple foodstuffs as the only realistic chance of prevention. This comes into effect from January 1998.

In the UK, we're much more reticent about adding things to the food chain. But folic acid is already added to 15 per cent of breads and 50 per cent of cereals, although it would take 12 slices or four bowls a day to prevent NTDs. Adding enough to flour so that everyone got 400mcg from, say, two slices of bread would not affect the taste of meet objections from millers. Neither would it be expensive - the money wasted on ineffective health education could have funded the programme for several years.

There is one argument against fortification - a very rare but potentially serious neurological side effect of folic acid can occur in elderly people with untreated Vitamin B12 deficiency. However, there is also a strong association between folic acid intake and the prevention of heart disease, which is likely to be of far more benefit to the elderly. If this proves to be the case, fortification is the only humane option. Although NTDs are rare, affecting only 0.3 per 1,000 live births, it is presently only abortion that prevents them from being 10 times as common. Folic acid is a far kinder and cheaper form of prevention, with the added benefit that you have a healthy baby at the end. For those who did the research, the knowledge that 7,000 pregnancies have since ended that could have been saved, and a 1,000 children with spina bifida could have had normal spines must be hard to take.

Today Helen Brinton MP tabled an Early Day Motion in the House of Commons calling for the addition of folic acid to flour