The Irish National Committee on Folic Acid Fortification was established in September 2004 with the brief of finding the most effective public health strategy reviewing the possible fortification of foods with the B vitamin in order to reduce the number of pregnancies affected by NTDs.
The recommended daily intake of folate for women of childbearing age is 400 micrograms, but in its report presented today to An Tánaiste and the Minister for Health and Children, the committee is only recommending 120 micrograms to give a good safety margin for those who consume large amounts of bread.
Around half of all pregnancies in Ireland are unplanned, and the country has one of the highest rates of neural tube defects in Europe - approximately 1-1.5 per 1,000 births (49 to 93 babies per year).
The committee expects that up to a quarter of NTD-affected pregnancies will be prevented by fortification at this recommended level, which will require "legislative change and minor modifications to the bread-making process".
Although the Food Safety Authority of Ireland (FSAI) has advised women planning to have babies to take folic acid supplements since 1993, these campaigns have had little success. Last year the FSAI initiated an education campaign aimed at women "who think they may have a baby one day" rather than just those planning a baby.
Spina bifida and anencephaly are the most common NTDs. Both conditions occur in the very early stages of pregnancy, often before women are aware that they are expecting.
Dietary folate is known to reduce the risk of these conditions. It occurs naturally in foods such as grains, lentils, chick peas and green leafy vegetables. Folic acid is a synthetic form of the nutrient which, according to the National Council on Folic Acid in the US, is actually better absorbed by the human body.
Food Standards Australia New Zealand (FSANZ) has also embarked on the path towards fortification, last month calling for public comment on a proposal that would require all bread-making flour to be fortified with folic acid.
Each year 300 to 350 pregnancies in Australia and around 70 in New Zealand are affected by neural tube defects.
Some voices have already been raise in favour of fortification in the region - although the Australian Food and Grocery Council has said that mandatory addition of the vitamin should be extended to other foods such as milk and yoghurt, since women tend to eat only around 11 slices of bread a week, giving enough folate to meet only one day's requirement.
But George Weston Foods, one of two Australian bakers that account for three quarters of all bread sales, says it has written to federal and state ministers urging them to reject the FSANZ proposal.
The company claims the proposal ignores both up-to-date information on women's current diets as well as adequate knowledge of the risks to others in the population from consuming more folic acid.
"Legal opinion shows that if government gets it wrong, industry will be liable," said the firm's spokesperson.
George Weston cited the case of the UK, which has stalled over introducing mandatory fortification on the grounds that it might mask vitamin B12 deficiency in the elderly.
Despite a positive preliminary report from the UK's Food Standards Agency in April, the government body has since said it needs more time to make a full assessment of the implications of investigations raising folate intake over 1mg per day.
A level of the fortification has not yet been proposed in the UK, but it could be anywhere between 100 and 450 micrograms per 100g.
Some UK lobby grounds have vociferously opposed mandatory fortification of bread products on the grounds of consumer choice. Ireland plans to allow for consumer choice by excluding some minor bread products and retail flour from the requirements.