A STUDY OF THE FOLIC ACID STATUS OF PREGNANT WOMEN IN AMINU KANO TEACHING HOSPITAL, KANO, NIGERIA

Abstract

Background:
Folic acid deficiency is implicated in the aetiology of nutritional anaemia and
adverse pregnancy outcomes. Such pregnancy outcomes affects not only the
mother with respect to increased morbidity and mortality, it also affects fetal
outcomes including prematurity and congenital anomalies. Folate deficiency is
easily correctable and it is desirable to document the prevalence of this deficiency
in population of pregnant women so as to inform some public health changes.
Study population:
Subjects: All pregnant women attending antenatal clinic at Aminu kano teaching
hospital between October 2009 to January 2010 who consented to be part of the
study and who have not been transfused. Age matched non pregnant apparently
healthy women attending family planning unit of Aminu Kano Teaching hospital
were studied as control.
Methods :
Structured questionnaire were administered to consenting participants to obtain
compliance to folic acid use, parity, gestational age and educational status. All
participants were bled for Full blood count, stool microscopy and red cell folate.
Haemoglobin electrophoresis was also done to exclude subjects who may have
haemoglobinopathies.
Major study outcome:
Number of subjects with folate level below the lower reference value of
400ng/ml.
Results:
A total of 160 participants were recruited into the study, 40 controls and 120 pregnant women. Of the 120 pregnant women, 40 in the 1st trimester, 40 in the 2nd trimester and 40 in the 3rd trimester. The mean red cell folate were 722 ± 216
and 586 ± 180.80 ng/ml respectively (p<0.001) .
None of the controls had folate level less than 400ng/ml, 14 of the subjects had folate deficiency (<400ng/ml). Pregnancy predisposes to folate deficiency. ( =
5.11, P = 0.023 ).
Defining anaemia in pregnancy as PCV < 30%, none of the controls was anaemic.
Of the 120 pregnant women, only 51 were not anaemic and none of these was
folate deficient. 69 (57.5%) of the pregnant women were anaemic and of these,
14 were folate deficient. Pregnant anemic women have increased likelihood of
folate deficiency as cause of the anaemia. (Chi square = 11.7, P= 0.0062). With 2, 4 and 8 of each of the 40 women in the 1st,2nd and 3rd trimesters respectively were
folate deficient. Folate deficiency increases with gestational age but this did not
reach significant level. (chi square = 4.53, P= 0.013).
The mean folate level appears to be highest among the nulliparous women
(644.54 ± 200.54ng/ml) and decreases with increasing parity (the multiparous and
grand multiparous having 550.68 ± 177.78 ng/ml and 531 ± 109 ng/ml
respectively. This decrease did not reach significant level. (F=1.467, P=0.32)

Of the 95 (79%) subjects that were folate supplement compliant only 2 were
deficient in folic acid whereas 12 (48%) of the 25 non compliant were folate
deficient. Folic acid deficiency in pregnancy is strongly associated with drug non compliance.  = 40.45, Fischer’s exact probability = 0.0000.
Subjects with no formal education have significantly lower folate (377.3) level
compared with those with tertiary education (599.53 ± 568) P=0.02. They also
have lower folate level when compared with those with primary and secondary
education but this did not reach significant level. P = 0.093 and 0.061 respectively.

Conclusion :
Folate deficiency is common in pregnant anaemic women in Kano, 11.6% of the
pregnant anaemic women being folate deficient. 85% of the women who are
folate deficient are not folate supplement compliant.

A STUDY OF THE FOLIC ACID STATUS OF PREGNANT WOMEN IN AMINU KANO TEACHING HOSPITAL, KANO, NIGERIA