Skip to main content
NCBI home page
Canadian Medical Association Journal logoLink to Canadian Medical Association Journal
. 1966 Oct 15;95(16):797–806.

The Incidence and Prevention of Folate Deficiency in a Pregnant Clinic Population

Louis Lowenstein, George Cantlie, Oscar Ramos, Lauder Brunton
PMCID: PMC1935759  PMID: 5928519

Abstract

Non-anemic women attending a public antenatal clinic were given, daily, a multivitamin tablet containing 78 mg. of elemental iron. The follow-up studies included an analysis of their diets. A total of 311 patients were included, of which one group received a supplement of 0.5 mg. folic acid and 0.005 mg. vitamin B12. The incidence of megaloblastic bone marrow change in the unsupplemented group was 26% and of low blood folates approximately 50%. The incidence of megaloblastic changes was sharply reduced in the supplemented group and the blood folates were elevated to supranormal levels, indicating that the dose of folic acid used may have been above the minimal requirement. Formiminoglutamic acid (FIGLU) excretion could not be correlated with other parameters of folate deficiency. Neutrophil lobe counts did not relate to megaloblastic changes or low folate levels unless there was more than 5% hypersegmentation. The dietary intake was suboptimal in total calories, iron and food folate.

Full text

PDF
797

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Alperin J. B., Hutchinson H. T., Levin W. C. Studies of folic acid requirements in megaloblastic anemia of pregnancy. Arch Intern Med. 1966 May;117(5):681–688. [PubMed] [Google Scholar]
  2. BADENOCH J., CALLENDER S. T., EVANS J. R., TURNBULL A. L., WITTS L. J. Megaloblastic anaemia of pregnancy and the puerperium. Br Med J. 1955 May 21;1(4924):1245–1247. doi: 10.1136/bmj.1.4924.1245. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. BUTTERWORTH C. E., Jr, SANTINI R., Jr, FROMMEYER W. B., Jr THE PTEROYLGLUTAMATE COMPONENTS OF AMERICAN DIETS AS DETERMINED BY CHROMATOGRAPHIC FRACTIONATION. J Clin Invest. 1963 Dec;42:1929–1939. doi: 10.1172/JCI104879. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. CHANARIN I., BENNETT M. C. A spectrophotometric method for estimating formimino-glutamic and urocanic acid. Br Med J. 1962 Jan 6;1(5270):27–29. doi: 10.1136/bmj.1.5270.27. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. CHANARIN I., BENNETT M. C., BERRY V. Urinary excretion of histidine derivatives in megaloblastic anaemia and other conditions and comparison with the folic acid clearance test. J Clin Pathol. 1962 May;15:269–273. doi: 10.1136/jcp.15.3.269. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. CHANARIN I., ROTHMAN D. RESPONSE TO FOLIC AND FOLINIC ACID IN MEGALOBLASTIC ANAEMIA IN PREGNANCY. J Obstet Gynaecol Br Commonw. 1965 Jun;72:374–375. doi: 10.1111/j.1471-0528.1965.tb01471.x. [DOI] [PubMed] [Google Scholar]
  7. CHANARIN I. STUDIES ON URINARY FORMIMINOGLUTAMIC ACID EXCRETION. Proc R Soc Med. 1964 May;57:384–388. [PMC free article] [PubMed] [Google Scholar]
  8. CHANARIN I. Urocanic acid and formimino-glutamic acid excretion in megaloblastic anaemia and other conditions: the effect of specific therapy. Br J Haematol. 1963 Apr;9:141–157. doi: 10.1111/j.1365-2141.1963.tb05452.x. [DOI] [PubMed] [Google Scholar]
  9. CHISHOLM M., SHARP A. A. FORMIMINO-GLUTAMIC ACID EXCRETION IN ANAEMIA OF PREGNANCY. Br Med J. 1964 Nov 28;2(5421):1366–1369. doi: 10.1136/bmj.2.5421.1366. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. COOPER B. A., LOWENSTEIN L. RELATIVE FOLATE DEFICIENCY OF ERYTHROCYTES IN PERNICIOUS ANEMIA AND ITS CORRECTION WITH CYANOCOBALAMIN. Blood. 1964 Nov;24:502–521. [PubMed] [Google Scholar]
  11. Chanarin I., Hutchinson M., McLean A., Moule M. Hepatic folate in man. Br Med J. 1966 Feb 12;1(5484):396–399. doi: 10.1136/bmj.1.5484.396. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Cooper B. A., Lowenstein L. Vitamin B-12-folate interrelationships in megaloblastic anaemia. Br J Haematol. 1966 May;12(3):283–296. doi: 10.1111/j.1365-2141.1966.tb05635.x. [DOI] [PubMed] [Google Scholar]
  13. Cowan J. D., Haffbrand A. V., Mollin D. L. Effect of serum-factors other than folate on the Lactobacillus casei assay. Lancet. 1966 Jan 1;1(7427):11–14. doi: 10.1016/s0140-6736(66)90004-3. [DOI] [PubMed] [Google Scholar]
  14. DAWSON D. W., MORE J. R., AIRD D. C. Prevention of megalo-blastic anaemia in pregnancy by folic acid. Lancet. 1962 Nov 17;2(7264):1015–1018. doi: 10.1016/s0140-6736(62)92702-2. [DOI] [PubMed] [Google Scholar]
  15. De Leeuw N. K., Lowenstein L., Hsieh Y. S. Iron deficiency and hydremia in normal pregnancy. Medicine (Baltimore) 1966 Jul;45(4):291–315. doi: 10.1097/00005792-196607000-00002. [DOI] [PubMed] [Google Scholar]
  16. FORSHAW J. W., JONES A. T., CHISHOLM W. N., MCGINLEY W. K. Megaloblastic anaemia of pregnancy and the puerperium. J Obstet Gynaecol Br Emp. 1957 Apr;64(2):255–262. doi: 10.1111/j.1471-0528.1957.tb02631.x. [DOI] [PubMed] [Google Scholar]
  17. GILES C., BURTON H. Observations on prevention and diagnosis of anaemia in pregnancy. Br Med J. 1960 Aug 27;2(5199):636–640. doi: 10.1136/bmj.2.5199.636. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. GILES C., SHUTTLEWORTH E. M. Megaloblastic anaemia of pregnancy and the puerperium. Lancet. 1958 Dec 27;2(7061):1341–1347. doi: 10.1016/s0140-6736(58)91437-5. [DOI] [PubMed] [Google Scholar]
  19. Grzesiukowicz H., Jennison R. F., Gowenlock A. H. Enzymatic release of folate activity from the red cells in megaloblastic anaemia of pregnancy. J Clin Pathol. 1965 Sep;18(5):599–604. doi: 10.1136/jcp.18.5.599. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. HANSEN H. A., WEINFELD A. Metabolic effects and diagnostic value of small doses of folic acid and B12 in megaloblastic anemias. Acta Med Scand. 1962 Oct;172:427–443. doi: 10.1111/j.0954-6820.1962.tb07176.x. [DOI] [PubMed] [Google Scholar]
  21. HERBERT V. Experimental nutritional folate deficiency in man. Trans Assoc Am Physicians. 1962;75:307–320. [PubMed] [Google Scholar]
  22. HERBERT V. Minimal daily adult folate requirement. Arch Intern Med. 1962 Nov;110:649–652. doi: 10.1001/archinte.1962.03620230095013. [DOI] [PubMed] [Google Scholar]
  23. HIBBARD E. D. FIGLU excretion. A screening test for folic acid deficiency in pregnancy. J Obstet Gynaecol Br Emp. 1962 Oct;69:739–741. doi: 10.1111/j.1471-0528.1962.tb01273.x. [DOI] [PubMed] [Google Scholar]
  24. HUSAIN O. A., ROTHMAN D., ELLIS L. FOLIC ACID DEFICIENCY IN PREGNANCY. J Obstet Gynaecol Br Commonw. 1963 Oct;70:821–827. doi: 10.1111/j.1471-0528.1963.tb04985.x. [DOI] [PubMed] [Google Scholar]
  25. JOHNS D. G., BERTINO J. R. FOLATES AND MEGALOBLASTIC ANEMIA: A REVIEW. Clin Pharmacol Ther. 1965 May-Jun;6:372–392. doi: 10.1002/cpt196563372. [DOI] [PubMed] [Google Scholar]
  26. LEEVY C. M., BAKER H., TENHOVE W., FRANK O., CHERRICK G. R. B-COMPLEX VITAMINS IN LIVER DISEASE OF THE ALCOHOLIC. Am J Clin Nutr. 1965 Apr;16:339–346. doi: 10.1093/ajcn/16.4.339. [DOI] [PubMed] [Google Scholar]
  27. LOWENSTEIN L., BRAMLAGE C. A. The bone marrow in pregnancy and the puerperium. Blood. 1957 Mar;12(3):261–277. [PubMed] [Google Scholar]
  28. LOWENSTEIN L., PICK C., PHILPOTT N. Megaloblastic anemia of pregnancy and the puerperium. Am J Obstet Gynecol. 1955 Dec;70(6):1309–1337. [PubMed] [Google Scholar]
  29. Lowenstein L., Brunton L., Hsieh Y. S. Nutritional anemia and megaloblastosis in pregnancy. Can Med Assoc J. 1966 Mar 26;94(13):636–645. [PMC free article] [PubMed] [Google Scholar]
  30. METZ J., FESTENSTEIN H., WELCH P. EFFECT OF FOLIC ACID AND VITAMIN B12 SUPPLEMENTATION ON TESTS OF FOLATE AND VITAMIN B12 NUTRITION IN PREGNANCY. Am J Clin Nutr. 1965 Jun;16:472–479. doi: 10.1093/ajcn/16.6.472. [DOI] [PubMed] [Google Scholar]
  31. METZ J., STEVENS K., BRANDT V. Urinary formiminoglutamic acid in the megaloblastic anaemias associated with pregnancy and malnutrition. Br Med J. 1962 Dec 1;2(5317):1440–1441. doi: 10.1136/bmj.2.5317.1440. [DOI] [PMC free article] [PubMed] [Google Scholar]
  32. SCOTT J. M., SOMMERVILLE J. W. PRACTICAL EVALUATION OF THE FIGLU TEST IN PREGNANCY WITH SPECIAL REFERENCE TO THE WHITE CELL CHANGES. J Clin Pathol. 1965 May;18:322–326. doi: 10.1136/jcp.18.3.322. [DOI] [PMC free article] [PubMed] [Google Scholar]
  33. TASKER P. W. Folic acid and vitamin B12. Effects of graded doses in the treatment of tropical nutritional megaloblastic anaemia. Trans R Soc Trop Med Hyg. 1960 Nov;54:578–581. doi: 10.1016/0035-9203(60)90034-1. [DOI] [PubMed] [Google Scholar]
  34. VITALE J. J., STREIFF R. R., HELLERSTEIN E. E. FOLATE METABOLISM AND IRON DEFICIENCY. Lancet. 1965 Aug 21;2(7408):393–394. doi: 10.1016/s0140-6736(65)90383-1. [DOI] [PubMed] [Google Scholar]

Articles from Canadian Medical Association Journal are provided here courtesy of Canadian Medical Association

RESOURCES