Why doctors want vitamin B12 and folic acid added to tea to prevent birth defects

More than 1,00,000 babies are born with neural tube defects (NTDs) — serious birth defects affecting the brain and spine that develop in the earliest weeks of pregnancy — in India every year, according to a report prepared by an expert panel constituted by the National Academy of Medical Sciences (NAMS), the apex medical advisory body to the Government. The estimate translates to nearly 300 affected births every day. Many of these babies do not survive, while others undergo repeated surgeries and require lifelong medical care.

Arguing that a large proportion of these cases can be prevented, the panel has proposed an unusual solution: fortifying tea with folic acid and vitamin B12 and making it widely available to women before pregnancy. The recommendation comes in a 55-page report, ‘Prevention of Neural Tube Defects in India,’ recently published in the ‘Annals of the National Academy of Medical Sciences (India).’

Prepared by a multidisciplinary expert task force, the report argues that tea is an ideal vehicle for fortification because it can be centrally processed, distributed across the country, is widely consumed, affordable and culturally acceptable. According to the panel, ensuring women have adequate folic acid and vitamin B12 levels before conception could prevent a substantial proportion of neural tube defects.

“It is important in the national interest that once this tea is made available by the government and tea companies, it could save nearly 90,000 babies every year from being born with defects of the brain and spine,” said Dr Ravindra M Vora, professor of Paediatric Surgery at Bharati Vidyapeeth Medical College and Hospital, Sangli, Maharashtra and one of the authors of the report. “Many of these children live severely handicapped lives. Only about 20 per cent can be treated surgically. Another 20 to 30 per cent can be helped with multiple operations. For some patients, we cannot do anything. It is a very difficult life for them and their families,” he added.

Why neural tube defects are a challenge

This is a problem that begins before most women know they are pregnant. The neural tube closes within the first month after conception, often before a woman has missed a menstrual cycle or realised she is pregnant. By the time pregnancy is confirmed, the critical window for prevention may already have passed.

For decades, doctors around the world have known that folic acid can dramatically reduce the risk of neural tube defects. Several countries, including the US, Canada, Australia and many nations in Latin America, have reduced rates of these birth defects through mandatory fortification of staple foods such as wheat flour.

India presents a different challenge. Unlike countries where a single staple dominates the national diet, Indians consume different foods depending on geography, culture and income. Wheat is common in northern India, rice dominates much of the south and east, while millets and other grains remain important in many regions. As a result, identifying a single food vehicle that reaches most women has proved difficult.

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Why tea?

According to the researchers, tea is one of the few products consumed across regions, communities and income groups. “We found that tea is consumed by a majority of women in India. Even if consumption is lower in some regions, at least 80 per cent of women drink tea. That makes it an ideal vehicle for supplying folic acid and vitamin B12 to adolescent girls and women who may become pregnant,” Dr Vora said.

The idea emerged after researchers began exploring why India had not adopted an effective nationwide strategy despite decades of evidence linking folic acid with prevention of neural tube defects.

Why vitamin B12 matters

In many countries, neural tube defect prevention focuses primarily on folic acid. India, however, also has widespread vitamin B12 deficiency, partly because the vitamin is found mainly in foods of animal origin and many Indians consume vegetarian or predominantly vegetarian diets.

The report cites studies showing high rates of vitamin B12 deficiency among women of child-bearing age across different regions of the country. In some studies, more than two-thirds of women had deficient or insufficient vitamin B12 levels.

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According to the authors, this means India’s fortification strategy should include both folic acid and vitamin B12 rather than folic acid alone.

Has the idea been tested?

Over the past several years, researchers in Sangli, Maharashtra, and Dibrugarh, Assam, conducted pilot studies involving women aged 18 to 30 who consumed either tea fortified with folic acid and vitamin B12 or plain tea. Blood tests before and after the intervention measured vitamin B12, folate, haemoglobin and other nutritional markers.

The findings encouraged the team to pursue larger studies and eventually prepare the NAMS report. Researchers are now conducting additional work to determine the most effective dosage for large-scale use. The formulation tested involved two grams of tea granules per cup fortified with one milligram each of folic acid and vitamin B12.

Could it be affordable?

According to the researchers, the vitamins required for three months of supplementation would cost about Rs 18 per person, making the approach significantly cheaper than purchasing vitamin tablets over the same period. “Tea also offers another practical advantage. It can be fortified during processing and distributed through existing supply chains without requiring changes in dietary habits. The report says discussions with scientists and stakeholders in the tea industry suggest the process is technically feasible and does not alter the colour, aroma or taste of tea,” Dr Vora said.

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What exactly is being proposed?

The report outlines a three-part national strategy. First, it recommends a nationwide awareness campaign to educate adolescent girls and women about the importance of folic acid and vitamin B12 before pregnancy. Second, it proposes fortifying suitable food vehicles with these vitamins, with tea identified as a promising option. Third, it recommends creating a National Birth Defects Surveillance Registry to accurately track neural tube defects and evaluate whether prevention programmes are working.

What happens next?

The report is expected to be discussed with the Ministry of Health and Family Welfare and the Tea Board of India. According to the authors, any future rollout would require coordination between health authorities, regulators and the tea industry, along with decisions on implementation, monitoring and distribution.