In a pregnant patient with sickle cell disease, which condition requires ongoing folic acid supplementation throughout pregnancy?

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

Answer: (D)

Folate is essential for DNA synthesis during the rapid production of red blood cells that occurs with chronic hemolysis in sickle cell disease. In pregnancy, this demand is amplified because the body is making even more blood cells to support the developing fetus. In HbS disease, the ongoing breakdown of sickled cells means folate stores can be depleted, so continuing high-dose folic acid throughout pregnancy (and lactation) helps prevent folate deficiency and megaloblastic anemia. Therefore, the condition that requires ongoing folic acid supplementation is sickle cell disease (HbS disease). A higher dose is typically used during pregnancy (often around 4 mg daily) compared with the standard prenatal amount. Sickle cell trait does not usually cause enough red cell turnover to require this extra folate, and neural tube defect prevention relates to folate earlier in pregnancy, not the ongoing need during the rest of gestation.