A 25-year-old woman is prescribed folic acid 5 mg daily with maternity exemption. Which condition would require continuing folic acid throughout the entire pregnancy?

• A. Neural tube defects
• B. Sickle cell trait
• C. Haemoglobin S Disease
• D. None

Answer: (C)

Folate is essential for rapid cell growth and DNA synthesis, which both the developing fetus and the mother’s expanding tissues require during pregnancy. When a woman has sickle cell disease (HbS), there is ongoing high red blood cell turnover due to hemolysis. This continually raises folate needs, so supplementing throughout pregnancy helps prevent folate deficiency that could worsen anemia and potentially affect fetal development. Neural tube defect prevention relies on folate around conception and early pregnancy to ensure proper neural tube closure, but the need for continuing high-dose folate throughout the entire pregnancy isn’t universally required unless another risk is present. Therefore, in HbS disease, continuing folic acid through pregnancy is the most appropriate rationale.