Folate deficiency natural history, complications and prognosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
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Overview
Natural History
Natural History
- The symptoms of (disease name) usually develop in the first/ second/ third decade of life, and start with symptoms such as ___.
- The symptoms of (disease name) typically develop ___ years after exposure to ___.
- If left untreated, [#]% of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].
Complications
- Common complications of [disease name] include:
- [Complication 1]
- [Complication 2]
- [Complication 3]
Complications
Some of the common complications include :
- Hematologic deficits : Inadequately treated or untreated patients will have megaloblastic anemia, leukopenia, and thrombocytopenia.
- Neural tube defects : Folate deficiency in pregnant women increases the incidence of neural tube defects in their fetuses. This can be effectively prevented by increasing folic acid intake preconceptually and during pregnancy.
- Neuropathy : Initiation of folic acid therapy may lead to progression of neuropathy and cognitive impairment in underlying vitamin B12 deficiency. This can be prevented by prompt diagnosis and treatment of vitamin B12 deficiency before instituting folic acid therapy.
- Cardiovascular disease : Moderate elevation of plasma homocysteine is an independent risk factor for cardiovascular disease, stroke, and venous thrombosis
- Colorectal cancer : High folate levels inhibit malignant transformation, but high folate levels may also enhance the growth of established malignancies. Some studies have suggested a possible link between low folate status and colorectal cancer .However, scientific evidence is not sufficiently clear to recommend increased folate intake for populations at risk for developing colorectal cancer.
- Toxicity : Evidence is emerging of possible toxicities associated with excess folate intake as a result of folic acid food fortification and use of dietary supplements containing folic acid. Toxicities include progressive neurologic damage, cognitive impairment (particularly in individuals with concomitant vitamin B12 deficiency), and enhanced growth of malignant tumors (specifically colonic tumors). Large doses of intravenous folic acid have been reported to exacerbate seizures in patients with underlying seizure disorders.
- Fertility : Folate deficiency can also affect fertility. However, the effects are only temporary and can be reversed by using vitamin supplements.
- Premature birth : As well as affecting your baby's growth, a lack of folate during your pregnancy may also increase the risk of your baby being born prematurely (before week 37 of the pregnancy).
Prognosis
Therapy often consists of giving oral folic acid, which is simple and inexpensive. Even in patients with malabsorptive disorders, folic acid is better absorbed than natural folate present in food. Hematologic parameters usually normalize after 8 weeks of therapy. Body stores can be replenished with additional treatment for 1 month. Patients with ongoing folate loss (e.g., malabsorptive disorders) and those with a continued state of increased demand (e.g., pregnancy) usually need continued supplementation.These people are at high risk for folate deficiency and it is advisable to monitor such patients periodically for both folate and vitamin B12 deficiencies.
Dietary modification : Patients consuming a folate-poor diet should include foods rich in folate. Alternatives include consuming foods fortified with folic acid or supplementing folate through multivitamin intake.