From the Guidelines
Vitamin B12 deficiency in pregnancy should be treated with 1000-2000 μg/d sublingual or intramuscularly.
Treatment Details
- The treatment for Vitamin B12 deficiency in pregnancy involves supplementation with Vitamin B12, with a recommended dose of 1000-2000 μg/d sublingually or intramuscularly 1.
- It is essential to monitor serum Vitamin B12 levels during pregnancy, especially in women who have undergone bariatric surgery, as they are at a higher risk of deficiency 1.
- Intramuscular Vitamin B12 injections may be necessary if oral therapy does not repair the deficiency 1.
- Women who are planning to become pregnant or are already pregnant should take a multivitamin and mineral supplement that contains Vitamin B12, as well as other essential nutrients like folic acid, iron, and calcium 1.
- The frequency of nutritional follow-up during pregnancy should be at least once in every trimester, with monitoring of serum Vitamin B12 levels and other micronutrients 1.
- Specialist antenatal care is recommended for women who have undergone bariatric surgery and are pregnant, to ensure proper monitoring and management of nutritional deficiencies 1.
- Breastfeeding mothers who have undergone bariatric surgery should be aware of the potential risk of Vitamin B12 deficiency in their infants and take necessary precautions 1.
From the Research
Treatment Options for Vitamin B12 Deficiency in Pregnancy
- Vitamin B12 deficiency can be treated with high-dose oral vitamin B12 supplementation or parenteral administration 2, 3, 4, 5
- Initial treatment with parenteral B12 is regarded as the first choice for patients with acute and severe manifestations of B12 deficiency 4
- High-dose oral B12 at different frequencies may be considered for long-term treatment 4, 5
- Prophylactic B12 supplementation should be considered for specific high-risk groups, such as pregnant women with a history of veganism or vegetarianism 6, 4
Diagnosis and Screening
- Diagnosis of vitamin B12 deficiency is often difficult due to diverse symptoms and marked differences in diagnostic assays' performance 5
- Serum B12 concentration is useful as a screening marker, and methylmalonic acid or homocysteine can support the diagnosis 3, 4
- Newborn screening for vitamin B12 deficiency using second-tier strategies by measuring homocysteine and methylmalonic acid in dried blood spots has been proposed 2
Prevention and Management
- Prevention and early treatment of B12 deficiency is essential to avoid irreversible neurological consequences 5
- Reduced dietary intake of B12 requires oral supplementation, while B12 malabsorption may require parenteral supplementation 5
- Long-term B12 supplementation is effective and safe, but responses to treatment may vary considerably, and individualized treatment plans may be necessary 5