If a woman gets to term and into labour still having folic acid deficiency anaemia, this should be regarded as some kind of failure of management. It is such an easy problem to correct.
No specific measures are required or called for in a case of folic acid deficiency anaemia in labour. The usual precautions for anaemia (regardless of type) will, of course, be taken. These may include cross-matching blood to have it ready in case transfusion becomes necessary, especially post-delivery.
Yes, to some degree. A breast-fed baby will be completely dependent on the milk for his or her folic acid requirements, among other things. It follows, therefore, that for a mother who was noted to be folic acid-deficient antenatally, supplements will be advisable. For the majority, however, this is not necessary as long as she is getting the right diet. Normal diet supplies more than adequate folic acid, even for a breast-feeding mother.
Pretty rare. Of the three types of deficiency anaemias (iron, folic acid and vitamin B12), this is the least common by a long way.
Yes. Uncorrected vitamin B12 deficiency will make it extremely difficult to conceive. It is a cause of reduced fertility, albeit a rare one.
An average diet will supply more than adequate levels of vitamin B12. Animal products are undoubtedly the best source of this vitamin. Strict vegetarians may therefore be at some disadvantage in this regard and supplements may be required. Many processed food manufacturers add vitamin supplements, which may include B12.
Pernicious anaemia is a condition with which it is difficult to absorb vitamin B12 from the gut. The vitamin contained in food simply goes through unabsorbed to end up in the faeces. This leads to vitamin B12 deficiency and anaemia, hence its name. This may not be relevant as far as pregnancy is concerned, because it is unusual for this condition to occur during the reproductive years.
Another condition, called Tropical sprue, does cause vitamin B12 deficiency and this can occur at any age. It can therefore cause vitamin B12 deficiency in pregnancy. It is a malabsorption condition the cause of which is not clearly known.
Remedial action for these conditions is simple and entails giving injectable vitamin B12. These conditions are rare.
Is it possible for anaemia in pregnancy to be due to a combination of causes?
This is not unusual. Since iron-deficiency anaemia is the most common, treatment of anaemia with iron could unmask a co-existing folic acid deficiency. That will also have to be treated because the two play completely different roles; one cannot substitute for the other.
As mentioned before, vitamin B12 deficiency is rare but, in some extreme cases of eating disorders, this may be encountered.
A combination of all three deficiencies is probably extremely unlikely to be seen in pregnancy because such a person is unlikely to conceive in the first place. However, in medicine, never say never.
To cater for those who may have a combination of deficiencies, there are oral preparations available in which iron and folic acid have been combined. They are probably suitable for people who are taking supplements to prevent deficiency from developing. Generally, they are not as good for treatment where deficiency is already established.
Last update: September 19, 2013