Folate deficiency causes macrocytic anaemia and pancytopenia. In severe cases it may also be associated with neurological signs and symptoms such as memory loss and irritability. Poor nutrition, alcoholism or increased requirement state, such as in pregnancy and lactation are some of the causes for folate deficiency. Although folate supplementation is largely applicable to the first trimester, more studies should be looking into the efficacy of continuing folate supplementation throughout pregnancy.
We present two cases of pregnant women affected by severe folate deficiency. The first case was a 33 year old lady G12P7 who delivered at 38 weeks 6 days. She had an elective caesarean section for 3 previous caesarean sections. Prior to surgery she was transfused 3 units of blood as her haemoglobin (Hb) was found to be 63g/L. She also had low platelet of 62 × 109/L. Her folate was 0.9ug/L during pregnancy and so developed a severe megaloblastic anaemia.
The second case was a 27 year old G5P3. She had 3 previous postpartum haemorrhage following delivery and was taking iron supplements throughout pregnancy. She presented with reduced foetal movements at 37 weeks 3 days and Hb was found to be 54g/L. Haematinics confirmed Vitamin B 12 deficiency 84, folate 2.5 and ferritin 248.
In summary, our case report highlights the consequences of severe folate deficiency resulting in invasive treatment. Since early signs and symptoms of folate deficiency may be subtle and intake of folate is inadequate in certain socioeconomic groups, should folic acid be routinely supplemented throughout pregnancy?