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Pregnancy-specific reference ranges for haematological variables in a Scottish population
1Obstetrics and Gynaecology, Worcestershire Royal Hospital, Worcester, UK. rgane@doctors.org.uk
Summary
Pregnancy vitamin B12 deficiency is often misdiagnosed. Gestation-specific ranges for ferritin, folate, and hemoglobin are needed to avoid unnecessary treatment and ensure proper iron management for anemia.
Area of Science:
- Obstetrics and Gynecology
- Hematology
- Nutritional Science
Background:
- Traditional laboratory reference ranges for vitamin B12 (cobalamin) are often inappropriately applied during pregnancy.
- This can lead to overdiagnosis and unnecessary treatment of vitamin B12 deficiency in pregnant individuals.
Purpose of the Study:
- To establish gestation-specific reference ranges for key hematological variables including ferritin, folate, hemoglobin, and vitamin B12 in pregnant women.
- To investigate the prevalence of apparent vitamin B12 deficiency and its relationship with other nutritional markers in pregnancy.
Main Methods:
- A cross-sectional study involving 190 pregnant women (113 in the 1st trimester, 77 in the 3rd trimester).
- Measurement of serum ferritin, folate, hemoglobin, and vitamin B12 levels.
- Analysis of changes in these variables with advancing gestation.
Main Results:
- Significant decreases in ferritin, hemoglobin, and vitamin B12 were observed from the 1st to the 3rd trimester.
- 34% of women had 'low' vitamin B12 levels based on traditional ranges.
- Co-existing ferritin deficiency was common in women with anemia and apparent vitamin B12 deficiency.
- Postnatal re-testing showed spontaneous increases in vitamin B12 levels in a subset of women.
Conclusions:
- Implementing gestation-specific reference ranges for hematological parameters is crucial to reduce the inappropriate diagnosis of vitamin B12 deficiency in pregnancy.
- Ferritin deficiency is a significant co-factor in cases of apparent vitamin B12 deficiency and anemia during pregnancy.
- Iron supplementation should be considered the initial management strategy for pregnant women presenting with anemia and low vitamin B12 levels.
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