A recent legal ruling in London’s High Court sets a new and potentially worrying precedent for UK doctors. Evie Toombes, a 20-year-old professional show jumper who was born with spina bifida, successfully sued her mother’s GP on the grounds that her mother allegedly did not receive sufficient advice about the importance of folic acid supplements prior to conception.
Spina bifida is a congenital condition that occurs when the embryonic neural tube (which is a precursor to the brain and spinal cord) does not develop properly, potentially resulting in double incontinence, leg weakness, or even complete lower limb paralysis. It is a rare condition affecting approximately six out of every 10,000 babies, and is associated with vitamin B9 (folate) deficiency. Thus women who plan to become pregnant, and those in the early stages of pregnancy, are advised to take folic acid supplements, as doing so reduces – though does not eliminate – the risk of spina bifida.
In Ms Toombes’ case, her mother attended a consultation with GP Dr Philip Mitchell in February 2001 to seek pre-conception advice. Unsurprisingly, Dr Mitchell could not recall the particulars of a brief conversation he had over 20 years ago. The records he made that day allegedly read “Preconception counselling. adv. Folate if desired discussed.” Dr Mitchell also asserted that he typically advised women planning pregnancy to take daily folic acid supplements. However, Ms Toombes’ mother claimed that Dr Mitchell had not explained to her how folic acid reduces the chance of neural tube defects such as spina bifida developing. She further claimed that Dr Mitchell had told her folic acid supplements were “not necessary” so long as she had a good dietary intake.