Pregnancy folate deficiency

Resident in Pediatrics The Johns Hopkins Hospital Baltimore, Maryland Cholestasis of Pregnancy Folate Deficiency... 

Pregnancy (folate deficiency during pregnancy is an important cause otl neural tube defects)... 

Megaloblastic anemia results from insufficient active THF to support cell division in the bone marrow. Methotrexate inhibits DHF reductase, making it a useful antineoplastic drug. Folate deficiencies may be seen during pregnancy and in alcoholism. 

Folate deficiency during pregnancy is a major contributor to neural tube defects because of the critical role of folate in neuronal development. 

Folate deficiency can be dietary, especially in the eiderly, due to increased demand like in pregnancy, or due to maiabsorption syndromes. Agents which can cause folic acid deficiency with long-term use include phenytoin, oral contraceptives, isoniazid and glucocorticosteroids. In rare instances the use of dihydrofolate reductase inhibitors like trimethoprim, methotrexate or pyrimethamine can contribute to the occurrence of folate deficiency. Folinic acid can circumvent the need for the inhibited dihydrofolate reductase. 

Since sulfasalazine inhibits the absorption of folic acid, patients may become folate deficient during longterm therapy. Sulfasalazine decreases the bioavailabiUty of digoxin. Cholestyramine reduces the metabolism of sulfasalazine. Sulfasalazine causes a reversible decrease in sperm counts. Sulfasalazine is safe in pregnancy. 

Because both drugs may interfere with folic acid metabolism, their use during pregnancy is usually contraindicated by the potential for effects on the fetus, such as the development of neural tube defects associated with folate deficiency. The use of trimethoprim is contraindicated in patients with blood dyscrasias, hepatic damage, and renal impairment. 

Contraindications Hypersensitivity to TMP or SMX Megaloblastic anemia due to folate deficiency Pregnancy at term and nursing Infants <2 months of age ... 

Special Precautions Should be given with caution to patients with renal or hepatic impairment, folate deficiency, and severe allergy or asthma Pregnancy Category C ... 

Anyone taking diuretics for longer than six months may experience a folate, or folic acid, deficiency. Folic acid plays a part in the health and reproduction of virtually every cell in the body. It is responsible for protein metabolism, the prevention of neural tube defects in pregnancy, blood cell production, and the synthesis of neurotransmitters. Individuals with folate deficiencies may suffer from anemia, depression and other mood disorders, and may give birth to babies with neural tube defects. Supplementation with folic acid may be useful in reversing these effects. 

Botez M, Lambert B. Folate deficiency and restless legs syndrome in pregnancy. N Engl J Med 1977 297 670-. 

There has been an association between folate deficiency during the first weeks of pregnancy and neural tube defects, leading to a campaign to encourage folic acid intake. In as how much UV exposure might contribute to folate deficiency is still under discussion.126-128... 

Folate (pteroylglutamic acid) is essential for the synthesis and methylation of DNA during fetal and early postnatal development (Nunn et al., 1986). Folate deficiency may result from poor diet, malabsorption, from treatment with anticonvulsant drugs such as phenytoin or primidone, as well as from antifolate drugs such as methotrexate. Folate deficiency during pregnancy leads to an increased prevalence of fetal malformations such as spina bifida and related neural tube defects. Findings... 

DEFICIENCY Folate deficiency resembles B12 deficiency so far as the anemia goes, but without the neurologic abnormalities. Unlike B12, for which there are tremendous body stores, folate needs continued replacement, and poor diet is the most common cause of folate deficiency. Serum levels of folate may help establish the diagnosis. Pregnant women are encouraged to take folate in pregnancy to help prevent birth defects. 

Folale deficiency occurs in pregnancy on a wide scale. The increased utilization of the vitamin by die fetus and related tissues, as well as the secretion in milk during lactation, can place an increased demand on the dietary folates consumed by the mother. Sea ere folate deficiency leads to megaloblastic anemia. This disease, in which the synthesis of red blood cells is impaired, tends to occur with pregnancy in underdeveloped countries, but usually not in North America or Europe, Goat s milk is a poor source of folate and vitamin Bjj. Ovcrrchancc on goal s milk as a source of food for infants can result in a deficiency in these vitamins and in anemia. 

Because of the potential risk of folate deficiency it is sensible to avoid triamterene in pregnancy (13). 

INDICATIONS Prevention of iron and folate deficiency in pregnancy... 

DRUG Iron and folic acid INDICATIONS Prevention of iron and folate deficiency in pregnancy DOSE 1 tablet daily CHECK REFERENCE British National Formulary 54th edition, section 9.1.1.1... 

As has already been stated there is an increased requirement for the vitamin during pregnancy. This means that large numbers of women in the lower socioeconomic groups in many if not most countries will become folate deficient during pregnancy unless they are given additional folate to supplement that present in their diets. A similar problem exists with iron, and several pharmaceutical companies market a capsule which contains both iron and folic acid. 

Folate deficiency has been shown to be responsible for birth defects in rats. Armstrong and Monie (A4) have shown that malformations of the eyes occurred in folate-deficient fetuses and these included anophthalmia or microphthalmia, reduction or absence of the optic nerve fibers, duplication of the optic cup, and a number of other defects. However, in the rat these defects were associated with a deficiency of maternal folate during pregnancy particularly between the seventh and ninth days. 

Folate deficiency is said to inhibit DNA synthesis, a consequence of which is that the maturation of red blood cells is slowed, causing anemia. As for folate deficiency during pregnancy, this can be the side effect of drugs that interfere with folate metabolism. 

Trimetlioprim is contraindicated in patients witli a hypersensitivity to die drug and in those widi a creatine clearance of less diaii 15 inL/min. The drug is used cautiously in iiatients widi hepatic or renal impainnent and in patients widi m aloblastic anemia caused by folate deficiency. Trimedioprim is classified as a Pregnancy Cat ry C drug, and its use is not recommended during pregnancy and lactation. 

---