Pregnancy folic acid deficiency

High doses of folic acid can mask signs of B12 deficiency, which is a risk in elderly people. Patients taking phenytoin (Dilantin) for seizures should be cautious about taking folic acid because it can increase the risk of seizures. During the first trimester of pregnancy, folic acid deficiency can affect the development of the central nervous system (CNS) of the fetus this can lead to neural tube defects (NTDs) such as spina bifida, a defective closure of the bony structure of the spinal cord, or anencephaly, lack of brain mass formation... 

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. 

Folic acid deficiency symptoms include megaloblastic anemia, glossitis, diarrhea, and weight loss. The requirement for this vitamin increases during pregnancy and lactation. 

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. 

Like oral iron, parenteral iron is used too widely. When iron is truly needed, oral administration is generally preferable (9). Intractable gastrointestinal intolerance to oral formulations, hyperemesis in pregnancy, very severe blood loss, and possibly ulcerative colitis are some of the few valid indications for parenteral iron. A low ironbinding capacity (for example due to prior saturating iron therapy or malnutrition), folic acid deficiency, and an allergic constitution predispose the patient to adverse reactions to parenteral iron. Iron injections have been reported to provoke hemolytic anemia in cases of paroxysmal nocturnal hemoglobinuria. 

Compound oral iron preparations Iron and folic acid (capsules, tablets or solution) numerous proprietary preparations designed to prevent iron and folic acid deficiency during pregnancy Iron(ii) as sulfate or fumarate or glycine sulfate or iron (ill) ammonium sulfate (47-110 mg Fe ) + folic acid (350-500 pg)... 

Folic acid deficiency is one of the most common vitamin deficiencies in the United States, largely due to its association with excessive alcohol intake and pregnancy. Requirements for folate in pregnancy are about five times higher than normal daily requirements. 

A4. Armstrong, R. C., and Monie, I. W., Congenital eye defects in rats following maternal folic-acid deficiency during pregnancy. J. Embryol. Exp. Morphol. 16, 531-542 (1966). 

Folic acid deficiency can occur due to pregnancy, malabsorption syndromes or inadequate diet. Some drugs, for example phenytoin (used in epilepsy), oral contraceptives and isoniazid (used in treating tuberculosis), can cause reduced absorption of folic acid. Oral replacement therapy with folic acid is effective. 

Folic acid deficiency leading to a megaloblastic anaemia, which requires oral folic acid (bottom right), may occur in pregnancy (folate requirement is increased) and in malabsorption syndromes (e.g. sieai-orriioea and sprue). 

Supplement folic acid deficiency states, impaired absorption, increased requirements (pregnancy, increased stimulation with exogenic estrogens) treatment with folic acid antagonists... 

The folic acid group of vitamins was recognized by various effects on several test organisms. The simplest active member may be considered to be pteroylglutamic acid or folacin. This may be combined with extra molecules of glutamic acid. Experimental production of a deficiency of these factors has not been reported in man, but the anemia of certain diseases of man responds to folacin therapy. These diseases include sprue, megaloblastic anemia of infancy, nutritional macrocytic anemia, and the pernicious anemia of pregnancy. Folic acid is involved in some way with the metabolism of amino acids. 

These types of anemias, which occur in infancy (megaloblastic anemia) and pregnancy (macrocytic anemia) and are usually due to simple folic acid deficiency, respond rapidly to treatment with folic acid, without vitamin B-12. It is possible that in some cases these anemias are due to an unknown metabolic defect in the production of the folacin enzymes. 

Deficiency of folic acid Decreased intake, defective absorption, or increased demand (eg, in pregnancy) for folate... 

Folic acid (vitamin Bg) is a conjugate of a pteridine unit, p-aminobenzoic acid, and glutamic acid. Deficiency of folic acid leads to anaemia, and it is also standard practice to provide supplementation during pregnancy to reduce the incidence of spina bifida. 

Megaloblastic anem/a.- Treatment of megaloblastic anemias due to a deficiency of folic acid as seen in tropical or nontropical sprue, anemias of nutritional origin, pregnancy, infancy, or childhood. 

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. 

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