title: Pregnancy- and lactation-related folate deficiency in South Africa--a case for folate food fortification.
abstract: OBJECTIVE
  Characterisation of patients presenting with megaloblastic anaemia according to clinical, sociological, haematological and aetiological aspects of their disease, and use of these findings to increase awareness among clinicians and to make recommendations regarding changes in national health policy.
  
  
  METHODS
  This study included 104 patients presenting with megaloblastic anaemia to a large referral hospital over a 1-year period. Data were collected and analysed in terms of age, gender, parity, gravidity, duration of lactation, socio-economic status, geographical origins, diet, previous haematinic treatment, clinical presentation and haematological measurements.
  
  
  RESULTS
  The most common cause of megaloblastic anaemia was pernicious anaemia or probable pernicious anaemia (50%), followed by pregnancy- and lactation-related folate deficiency (32%); of these patients, the majority (28) presented postpartum while lactating; 5 patients were in the immediate puerperal period of 6 weeks, and a further 16 were seen during the first year and 7 during the second year following delivery. Only 4 patients were pregnant, and it is noteworthy that 2 of these were still lactating at 34 weeks' gestation.
  
  
  CONCLUSIONS
  Pregnancy- and lactation-related folate deficiency up to 2 years after delivery remains a common cause of megaloblastic anaemia in South Africa. Certain communities in rural South Africa have recently been shown to have high incidences of both neural tube defects and folate deficiency. The fortification of a staple food (e.g. maize or flour) with folic acid is feasible, inexpensive, safe and likely to be beneficial. This practice should reduce the prevalences of megaloblastic anaemia in fertile women, neural tube defects, other congenital abnormalities, intra-uterine growth retardation, prematurity and possibly cardiovascular disease. There is urgent need for a national policy in this regard.
authors.affiliation: Department of Haematology, School of Pathology, South African Institute for Medical Research, Johannesburg.
authors.forename: C F
authors.initials: CF
authors.lastname: Ingram
authors.forename: A F
authors.initials: AF
authors.lastname: Fleming
authors.forename: M
authors.initials: M
authors.lastname: Patel
authors.forename: J S
authors.initials: JS
authors.lastname: Galpin
mesh_terms: D000293:Adolescent; D000328:Adult; D000749:Anemia, Megaloblastic / Q000208:ethnology / Q000209:etiology* / Q000517:prevention & control*; D044383:Black People; D003627:Data Interpretation, Statistical; D005260:Female; D005492:Folic Acid / Q000627:therapeutic use; D005527:Food, Fortified; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D007501:Iron / Q000097:blood / Q000627:therapeutic use; D007774:Lactation; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D011188:Potassium / Q000097:blood; D011247:Pregnancy; D011250:Pregnancy Complications, Hematologic / Q000208:ethnology / Q000209:etiology* / Q000517:prevention & control*; D017701:Reticulocyte Count; D013019:South Africa / Q000453:epidemiology
chemical_list: D006454:Hemoglobins; D005492:Folic Acid; D007501:Iron; D011188:Potassium