Direct telephone: +44 (0) 20 7772 6369 Royal College of

Direct facsimile: +44 (0) 20 7772 6232

Email: cdhillon@rcog.org.uk Obstetricians and
Gynaecologists
9 March 2007
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Royal College of Obstetricians and Gynaecologists

Response to the Food Standards Agency’s consultation on
folic acid fortification

The Royal College of Obstetricians and Gynaecologists is very pleased to participate in

this important consultation. We have strongly supported fortification of bread flour since
2003. We would draw your attention to the RCOG Scientific Advisory Committee's
Opinion Paper: Periconceptional Folic Acid and Food Fortification in the Prevention of
Neural Tube Defects. It concludes:

Good quality scientific studies have shown that a major handicapping congenital
malformation can be prevented in high-risk groups either by supplementation or
fortification with folic acid. Health Education strategies have failed to ensure that a
majority of women take folic acid supplements preconceptionally. In particular, women
in the UK who are most at risk and thus most likely to benefit from supplementation are
also those least likely to be aware of it or to use it. Food fortification in the USA and
Canada has resulted in a sizeable reduction in NTD incidence. There is no evidence of
harm from this strategy, and considerable evidence of benefit. On this basis, the
Committee continues to recommend to the FSA and the DH that statutory fortification of
bread flour should be introduced at the level suggested in the COMA report.

This document is available from our website: http://www.rcog.org.uk/index.asp?PageID=541

In response to your current consultation:

We strongly support Option 4: Mandatory fortification of bread or flour with folic

acid. We would, however, also recommend ongoing further research and careful analysis
as to the potential adverse population effects.

If we can be of any further assistance please do not hesitate to contact me.

Professor Shaughn O'Brien FRCOG

Vice President - Standards