Dose of folic acid per day for treating megaloblastic anemia in pregnancy

Folic acid deficiency in Pregnancy In nonpregnant women, the folic acid requirement is 50 to 100 mg/day During pregnancy, requirements are increased and 400 mg/day is recommended The earliest biochemical evidence is low plasma folic acid concentrations Normal serum folate levels Non Pregnant women: 5.4-18ng/ml 1st trimester: 2.6-15ng/ml 2nd trimester: 0.8-24ng/ml 3rd trimester: 1.4-20.7ng/ml Early morphological changes usually include neutrophils that are hypersegmented and newly formed erythrocytes that are macrocytic As the anemia becomes more intense, peripheral nucleated erythrocytes appear, and bone marrow examination discloses megaloblastic erythropoiesis The fetus and placenta extract folate from maternal circulation so effectively that the fetus is not anemic despite severe maternal anemia Treatment As little as 1mg of folic acid administered orally once daily produces a striking hematological response By 4 to 7 days after beginning folic acid treatment, the reticulocyte count is increased, and leukopenia and thrombocytopenia are corrected American College of Obstetricians and Gynecologists (2013c) have recommended that all women of childbearing age consume at least 400 mg of folic acid daily Increased need of Folic acid Multifetal pregnancy Hemolytic anemia Crohn disease Alcoholism Inflammatory skin disorders Reference: William&;s Obstetrics; 24th Edition; Chapter 56