Book of Medical Disorders in Pregnancy - Tintash

granulocytes and thrombocyte is also
adversely effected.
Metabolism of folic acid: Folic acid is
pteroylmonoglutamic acid which can be
prepared synthetically. Conjugates of
this substance are present in most green
vegetables.
Daily requirements - The normal
requirements of folic acid are about 50
micrograms in the non pregnant patient.
The requirements increase to about 300
mcg daily during pregnancy. Average
diet of women in this country cannot
meet this extra demand of folic acid.
Routine supplementation of the diet is
therefore a sound practice. The normal
range of serum folate is 6 to 30 ng per
ml. This can fall during pregnancy to
level as low as 2.0 ng per ml. The serum
B12 level is closely linked with that of
folate level and may fall from the normal
figure of 150 to 350 mcg per ml. to under
100 mcg per ml. during pregnancy,
especially when folic acid deficiency is
present.
Causes of folate deficiency:
The causes of folate deficiency in
women are poor intake or impaired
absorption. This us-ually results from
frequent child bearing which does not
allow the woman time to replenish her
stores before the next pregnancy begins.
Whenever there is rapid turn over of red
cells as is the case in hemolytic anemia,
the demand for folic acid increases
greatly. Folate deficiency is a common
feature in all cases of anemia due to
hemoglobinopathies.
A pregnant woman who is
suffering from malaria also needs increased
amount of folic acid as hemo-
11
lysis is produced by the parasite. Patients
who have been on long term therapy
with sulphonamides or anticonvulsant
drugs can become deficient in folic acid
and require supplements of this vitamin
in their daily diet.
Incidence - Megaloblastic anaemia
occurs in 2.8 per cent of cases. The
condition is more common in
multigravida and in multiple pregnancies
than in primigravida.
Clinical picture - In contrast to iron
deficiency anemia the folic acid
deficiency develops late in pregnancy.
Sometimes mild hypertension and
albuminuria may develop. When the
patient complains of soreness of tongue,
anor-exia, vomiting or diarrhoea, the
Physi-cian should suspect folic acid
deficiency occasionally this type of
anaemia, may present as pyrexia of
unknown origin in the puerperium.
Preeclampsia is nearly five times
more commonly encountered in patients
with megaloblastic anaemia. 1t has been
reported that folic acid deficiency is
sometimes associated with accidental
hemorrhage. The cause and effect
relationship of this deficiency have not
been proven as yet. The hemoglobin
level can fall very low i.e. 3 to 4 gram
per cent, while the pack cell volume can
fall to 13-14 per cent. The MCV is
raised but M.C.H.C. is normal.
Blood picture:
The stained blood film shows
anisocytosis and poikilocytosis.
Megaloblast may be seen on
examination of the buffy coat.
Granulocytes will be low in number. The
neutrophil polymorphs with four or five