Megaloblastic Anemia due to Folic Acid Deficiency in a Young Woman on Oral Contraceptives

Abstract

Case report of a young woman, aged 27, suffering from severe megaloblastic anemia due to folic acid deficiency. The factor responsible for this deficiency seems to be the regular use of oral contraceptives for 3 years (Noracycline 22®). Recent investigation evidenced the existence of selective malabsorption of food folates, due to the action of hormonal contraceptives on the intestinal conjugase. It can thus be admitted that contraceptive drugs play a prominent part in the genesis of this type of anemia. However, other factors must also be considered, like malnutrition and a masked malabsorption syndrome. The relation with megaloblastic anemia in pregnancy is discussed

New Carrier Protein(s) of Folic Acid in Human Serum

“…The visible sign are lowered FAA levels in the serum. But it has been re ported recently that the influence of contraceptive hormone drugs on hu man FAA metabolism is similar [1, [8][9][10][11][12] and that anabolic hormones may raise the FAA level in serum and red cells [4]. Now, once the differ ent FAA carrier proteins are known, this problem of pregnancy can also be reconsidered, as soon as it is clear which of the different kinds of hor mones affect the binding of FAA to human proteins.…”

Oral contraceptive use: impact on folate, vitamin B6, and vitamin B12 status

“…Early observational studies of megaloblastic anemia in OC users conducted in the 1960s led to the hypothesis that the use of synthetic hormones may negatively impact folate status. [35][36][37][38][39] Subsequently, multiple studies were conducted to assess the impact of OC use on folate status in women of reproductive age with equivocal results. For example, both Shojania et al 40 and McLean et al 41 conducted studies that led to the conclusion that serum folate concentration was negatively associated with OC use.…”

“…This may be of clinical significance if a woman becomes pregnant shortly after discontinuing oral contraceptives.” The validity of this statement should be evaluated by an examination of research evidence related to the potential negative effects on folate status. Early observational studies of megaloblastic anemia in OC users conducted in the 1960s led to the hypothesis that the use of synthetic hormones may negatively impact folate status 35–39 . Subsequently, multiple studies were conducted to assess the impact of OC use on folate status in women of reproductive age with equivocal results.…”

A Review of the Effects of Oral Contraceptives on Nutrient Status, with Especial Consideration to Folate in UK

“…Shortly after the introduction of OCs, studies appeared in the literature to suggest their consumption might negatively impact on user's folate status [39][40][41][42][43]. For example, in 1968 Shojania et al reported in Lancet that in comparison to a control group, mean serum folate in OC users was lower and that the numbers of subnormal folate levels was higher too [44].…”

“…A C677T polymorphism in the MTHFR gene limits the activity of this enzyme and can cause enhanced thermolability, especially in states of folate deficiency [156]. Mutation homozygous individuals have significantly lower plasma folate levels and an elevated plasma Hcy [41,157,158]. It is not surprising that the MTHFR 677T mutation is associated with a higher risk of NTDs [159].…”