Folacin, cobalamin, and hematological status during pregnancy in rural Kenya: the influence of parity, gestation, and Plasmodium falciparum malaria

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Abstract
To investigate folacin concentrations in malaria during pregnancy, women attending a rural antenatal clinic in Kenya were studied. Low serum folacin values had poor specificity for low red blood cell (RBC) folacin concentrations. Multigravidae had lower mean serum folacin (p < 0.03) and RBC folacin (p < 0.001) values than Primigravidae. Primigravidae had higher mean RBC folacin values than nulliparae (p < 0.05). Although anemia was frequent, no evidence of neutrophil hyper-segmentation was seen in blood smears of individuals with low RBC folacin or indeterminate cobalamin values. The unexpectedly high RBC folacin concentrations are probably related to P falciparum infection: during followup a significant decrease in both RBC and serum folacin activity occurred after chloroquine was administered. This decrease may be unrelated to a gestational effect (RBC folacin p < 0.01; serum folacin p < 0.025). The pathogenesis of high RBC folacin activity is discussed in relation to reticulocytosis as well as to a biochemical mechanism within the RBC.