Question about impact of anaemia caused by folate deficiency in third trimester

[McPom]

Hi all,

I'm in the third trimester (33 weeks) of my pregnancy and the results of a blood test I had recently show that I have anaemia. I know that anaemia is caused by iron-deficiency and that it can be treated with iron tablets, but I also know that anaemia can be caused by a folate deficiency. This is what I'm concerned about, because I'm taking another medication which inhibits folic acid absorption.

I know that not getting enough folic acid during pregnancy can increase the risk of a baby developing a birth defect of the spine or brain (a neural tube defect), but that neural tube defects develop early on in pregnancy (which is why pregnant women have the nuchal translucency scan at 11-14 weeks.).

So, my question is this:

If my anaemia is caused by a deficiency in folic acid does anyone know if it could cause my baby to have a birth defect of the spine or brain, or, because the anaemia developed in the third trimester, does this mean that it's too late in the baby's development for a defect of this kind to occur?

Sorry for the long-winded email, but I've been mulling this over for a while now (I've been worrying about this sort of thing for the whole pregnancy and now the pregnancy is coming towards the end I'm anxious to meet the baby) and I?d be really grateful for any feedback.

Thanks very much in advance.

I'm certainly no expert but I thought that the neural tube, spine etc forms fairly early on. I would have thought any defects would almost certainly have been picked up by 20 weeks at the anomaly scan.
It's unlikely that you would have been more than slightly anaemic at this point, as the body has reserves which the baby draws on and they become depleted as the pregnancy progresses. I think the mother comes off worse than the baby as the baby takes what it needs.
I was anaemic through my pregnancy and I thought that the reason they repeatedly tested was mainly due to the implications for labour and delivery; for example you can't give birth at home or in a birthing centre where I live if you're anaemic. I was told I may possibly be at increased risk of haemorrhage and subsequently need a blood transfusion if I lost a sig amount of blood. The hospital has to set reserves of blood aside. It can also make you feel tired and weak after baby is born for a few weeks so they test again before you are discharged and may continue to prescribe iron tablets. So in summary I think it's poor mum who bears the brunt of it so try not to worry about baby!

Ditto my obstetrician told me it would be the mum that suffered not the baby. This was after the midwife told me I was endangering my baby by not eating red meat (not eaten it for 20 years and never been anaemic!)

Thanks WillowB for your reply - it's really helpful, informed and does put my mind at rest re: the health of the baby.

And thanks princesslina for your reply too - also helpful to know. I'm sorry about the guilt-trip from your midwife. I don't eat meat either.

Hello - did you take folic acid until 12 weeks, and were you on the higher dose of 5mg if you were also taking medication that lowers your folate at the time? The first trimester is the important time for neural tube development so I think if you've developed this in the third trimester I wouldn't be concerned about it (I'm a GP). If you're anaemic now it is important to establish the cause though, and get you topped up with iron or folate - whichever is the culprit. Even with the medication you are on, probably low iron is still the most likely cause but a blood test to check your levels of both of these should be done.

I got very anaemic in my third trimester with ds but didn't know about it as they didn't check my bloods after 28 weeks, and I assumed all pregnant women were that tired. It was only after giving birth with just a normal blood loss that I kept passing out and looked as white as a sheet and they checked my full blood count for me (which I had to argue for them to take!). I wished I'd had my bloods checked in the third trimester and taken iron as I then had problems with my milk coming in because my Hb was too low - I should have had a transfusion really but they wanted my bed and I stupidly let myself be sent home with tablets. But you have plenty of time to sort it out now and prevent any problems like that happening. x

Thanks for your reply mummy2benji. Lots of helpful information and useful advice; I appreciate it very much.

I did take the higher dosage of folic acid. I will ask my midwife if I can have a blood test to establish the cause of the anaemia. I'd certainly like to avoid passing out or needing a blood transfusion!

Thanks again.

Good plan - if she says that is outside what they usually test for (they'll check ferritin but don't usually check people's folate levels) then ask your GP and they can arrange it for you. x