Folic acid deficiency

-Folic acid is part of the vitamin B complex. -In pregnancy it is necessary for effective cell growth and synthesis of ribonucleic acid (RNA) and deoxyribonucleic acid (DNA) especially the embryo - a deficiency is associated with neural tube defects in the fetus. - Deficiency can be due to : multiple pregnancy, poor diet

adverse social circumstances may arise secondary to drug therapy such as antiepileptic drugs (AEDs). The average daily folate requirements rise in pregnancy from 50 to 400 µg/day Although this can usually be met through a healthy diet, women are encouraged to take prophylactic folic acid 400 µg/day (0.4 mg) routinely in the first trimester, which should be increased to 5 mg if the woman is also taking AEDs or other drugs affecting folate metabolism. Chronic maternal folate deficiency can lead to megaloblastic anemia

Megaloblastic anemia -Megaloblastic anemia refers to an abnormality of the erythroblasts in the bone marrow in which the maturation of the nucleus is delayed due to defective DNA synthesis resulting in the production of larger than normal red blood cells (macrocytosis). -This arises from a deficiency of either of two B vitamins, folic acid and cyanocobalmin (B12), both of which are necessary for DNA synthesis.

- A deficiency of vitamin B12 alone is termed pernicious anemia. -One third of pregnancies worldwide are affected by megaloblastic anemia, Megaloblastic anemia is secondary to: dietary deficiency (especially a vegan diet), alcoholism; gastrointestinal surgery autoimmune disease medical disorders, especially sickle cell disease drug therapy, e.g. azathioprine

-Diagnosis :history from the woman, undertaking a physical examination and investigations including a FBC, blood film and assessing serum concentrations of vitamin B12 and folate. -If vitamin B12 deficiency is evident, serum anti- intrinsic factor and antiparietal cell antibodies should be examined.

If folate levels are low, tests for anti-endomysial or anti-transglutaminase antibodies are likely to be performed -Treatment is determined according to the identity of the underlying cause. Supplements of folic acid and cyanocobalamin will be prescribed as necessary, and a referral to a dietician may be necessary.

-The midwife has an important role in identifying at-risk women and referring them to appropriate personnel, encouraging compliance with medication and providing dietary advice.