Clinical Analysis of 100 Cases of Severe Megaloblastic Anaemia of Pregnancy

The 100 cases of severe megaloblastic anemia diagnosed from 1953-58 at the Rotunda Hospital Dublin represent an incidence of 1 in 240 confinements. No significant seasonal pattern was noted. 30% of cases presented as patients with progressive anemia of pregnancy which failed to respond to oral or parenteral iron. 51 had edema 44 had albuminuria 23 had hypertension 17 had vomiting 71 had pyrexia 11 had urinary infection and 10 had diarrhea. 20 mg of folic acid daily caused a reticulocyte response and a rise in the hemoglobin level. Megaloblastic anemia arose as a complication of carcinoma of the stomach in 1 case Hodgkins disease in 1 case lymphoadenopathy in 1 case and epilepsy in 3 cases. 41 of 96 cases were diagnosed between 31 and 40 weeks gestation. Hypertension occurred in 23% of cases hypertension with edema or albuminuria in 22% and hypertension edema and albuminuria in 14% creating difficulties in the differentiation of the anemia from toxemia of pregnancy. The 100 cases included primagravidae; average parity was 3.8. 8 cases were multiple pregnancies and hydramnios was noted in 9. 22 of 80 known cases delivered before the 38th week an incidence of 27%. 23 infants from 17 pregnancies were premature by weight. The premature incidence in single pregnancies was 12.5%. 2 cases of postpartum hemorrhage and 1 of placenta previa were noted. Duration of labor method of delivery and incidence of induction of labor were not very different from the general population. There were 3 stillbirths not ascribed to the anemia. 5 neonatal deaths were due to prematurity and 1 to anencephaly. Puerperal morbidity occurred in 30% of cases and there were 2 deaths due to underlying significant disease. Recurrence of megaloblastic anemia occurred in a 2nd pregnancy in 4 cases in the 6-year period. The argument in favor of routine antenatal administration of folic acid is very strong.