NUTRITIONAL ANEMIA AND MEGALOBLASTOSIS IN PREGNANCY

Abstract

Macrogranulocytic and/or erythroid megaloblastic bone marrow changes which could not be accurately predicted from the hematologic findings in the blood were present in 25% of 305 mildly to moderately anemic pregnant women attending a public antepartum clinic in Montreal. Iron deficiency was the primary cause of anemia in most instances. Serum folate activity of less than 4.1 ng/ml and/or serum vitamin B12 levels of less than 100 pg/ml were present in 90% of the 77 patients having these bone marrow changes, whereas approximately one-third of 228 patients with normo-blastic marrow had these low values. Red cell folate did not correlate as well as serum folate activity with bone marrow changes. After treatment with oral folic acid in the range of 0.2 mg. to 0.8 mg, daily, for 7 to 14 days, the megaloblastic and macrogranulocytic changes in patients with low serum folate activity and normal serum vitamin B12 values disappeared in 15 of 21 patients. Of 5 women having both low folate and vitamin B12 values, three failed to respond and 2 showed only partial improvement after 0.4 mg of folic acid daily, per os, for 10 days. The average diet of these anemic women was suboptimal in folate and in iron.