Question to the Department of Health and Social Care:

To ask the Secretary of State for Health and Social Care, what assessment he has made of the potential implications for his policies of the article in The Lancet by Dr Czeizel entitled Can terathanasia explain the protective effect of folic-acid supplementation on birth defects, published on 16 August 1997, particularly the comment that fetal deaths could readily account for not just part of the effect of folic acid on prevention of defect in births, but for the entire effect.

In the United Kingdom, folic acid fortification was first considered by the Committee on Medical Aspects of Food and Nutrition Policy (COMA) in 2000.

In its report on Folic Acid and the Prevention of Disease, COMA considered the 1997 paper by Hook and Czeizelb, Can terathanasia explain the protective effect of folic-acid supplementation on birth defects?.

COMA noted that “It has been suggested that some agents that reduce the incidence of birth defects might do so by increasing the rate of death or abortion of affected fetuses ("terathanasia") and that the effect of folic acid on [neural tube defects] NTDs could be mediated by this means. For this reason, there has been some concern over an increased rate of spontaneous abortions among women taking folic acid supplements.”

COMA further noted that it “is most likely due, however, to an increase in fertility and multiple pregnancies among women taking supplements and to an effect of folate in allowing the survival of non-viable conceptuses to a stage where their loss is recognised as abortions. The generally accepted view is that folic acid supplements prevent NTDs simply by allowing the normal development of the fetal neural tube.”

Folic acid fortification was recommended by COMA in 2000 and by its successor the Scientific Advisory Committee on Nutrition (SACN) in 2006, after an extensive review of the evidence on folate and health. The SACN has further considered the evidence in its 2009 report to the Chief Medical Officer on folic acid and colorectal cancer risk and its 2017 update on folic acid and did not identify any further concerns on the issue.