Folic acid-deficiency anemia in Pregnancy

By Dr Joe Kabyemela, MD

Unlike iron, folic acid deficiency in pregnancy is uncommon. However, sometimes the two occur together.

Natural sources of folic acid

Folic acid is actually one of the ‘B’ group vitamins. It is also known as Vitamin B9. Practically all foodstuffs contain folic acid. This includes grains (such as corn and rice) as well as vegetables.

Unfortunately, folic acid is very susceptible to heat and is rapidly destroyed by cooking. Boiling vegetables for five minutes will destroy about 90% of their folic acid content. In normal circumstances, a proper balance and preparation of food generally provides adequate folic acid.

Conditions that require Folic acid supplementation

Women who suffer from conditions in which there is chronic destruction of red blood-cells need to take increased folic acid supplements. This is more so during pregnancy. Such conditions include sickle cell disease, thalassemia and hereditary spherocytosis. Women with these conditions will almost always be aware of this well before they conceive, because these are chronic conditions that they live with from childhood.

The recommended daily dose of folic acid in such circumstances is 5 mg. A higher dose of 10 mg or thereabouts is occasionally recommended when the problem is particularly serious. This is uncommon. In any case, many of these women will be taking folic acid even before conception and it will be a matter of checking whether the dose needs to be adjusted.

Women who suffer from epilepsy and who are taking anticonvulsant medication are also strongly advised to take folic acid supplements preferably at a dose of 5 mg daily. Ideally this should start before conception.

Twins and other forms of multiple pregnancy is another relative indication for folic acid supplements, because of the increased demand and therefore an increased risk of deficiency.

Folic acid deficiency effect on the baby

If the mother was folic acid deficient before conception, the risk of neural tube defects - especially spina bifida - is increased.

There is irrefutable evidence that folic acid supplements taken in the period leading up to conception and in the days immediately after will reduce the risk of spina bifida quite considerably. It is particularly crucial for mothers who have had an affected baby in the past.

Other anomalies that have been associated with pre-conception folic acid deficiency include cleft lip ("hare-lip") and cleft palate.

Risk of folic acid deficiency for the baby as a result of maternal deficiency

Not the unborn baby. Even when the mother is deficient of folic acid, the placenta will actively transport folic acid to the fetus to meet its needs. However, since the reserves are likely to be tenuous, the newborn is at risk of developing anemia as a result of folic acid deficiency within a few weeks of birth.

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