What is the relationship between maternal pernicious anemia (Vitamin B12 deficiency) and pregnancy outcomes?

From the Research

Healthcare providers should prioritize oral vitamin B12 supplementation with 1000 μg/d of cyanocobalamin for maternal pernicious anemia, as it has been shown to improve vitamin B12 deficiency in pernicious anemia, according to a recent prospective cohort study 1.

Diagnosis and Screening

Maternal pernicious anemia is an autoimmune disorder causing vitamin B12 deficiency during pregnancy that requires prompt diagnosis and treatment. Healthcare providers should screen pregnant women with risk factors or symptoms including:

• Fatigue
• Pallor
• Glossitis
• Neurological manifestations Diagnosis involves measuring serum B12 levels (below 200 pg/mL indicates deficiency), complete blood count showing macrocytic anemia, elevated homocysteine and methylmalonic acid levels, and testing for anti-intrinsic factor antibodies.

Treatment and Management

Treatment consists of oral vitamin B12 replacement, typically cyanocobalamin, with a dosage of 1000 μg/d, as shown to be effective in a prospective cohort study 1. Regular monitoring of B12 levels, complete blood counts, and clinical response is essential, with levels checked at least quarterly. Dietary counseling should emphasize B12-rich foods, though supplementation remains necessary. Multidisciplinary care involving obstetrics, hematology, and neurology may be required for optimal management of these patients.

Risks and Complications

Untreated pernicious anemia can lead to severe maternal complications including:

• Neurological damage
• Increased risk of thromboembolism While fetal risks include:
• Neural tube defects
• Preterm birth
• Developmental delays Prompt recognition and treatment of maternal pernicious anemia are crucial to prevent these complications, as highlighted in various studies 2, 3, 4.