What causes Vitamin D and B12 deficiency in early pregnancy?

Question

Hi doctor,

My wife is 29 years old, and we have a five-year-old son. It was a premature delivery in the 34th week, and it was a normal delivery. After that, she had three abortions, all are because of no fetal growth or heartbeat. Currently, she is ten weeks pregnant. Her recent ultrasound scan showed a normal and good heartbeat.

From the investigation report, we came to know that her vitamin D level is 12 and her B12 is 227. Will it impact the growth of the baby? Shall we continue the pregnancy? Fetal hemoglobin (HbF) 0.9%, hemoglobin A0 (HbA0) 96.5%, and above one year, 94.3 to 98.5% haemoglobin A2 (HbA2).

Please help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

The vitamin D levels are in the deficient range, and the vitamin B12 levels are normal. There is no need to discontinue the pregnancy due to these values. Vitamin D supplementation will help to have adequate levels in a baby. I suggest vitamin D supplementation with a Calcirol sachet of 60000 IU weekly after the 12th week of pregnancy for eight weeks. Consult your doctor, discuss with him or her and take the medicine with consent. I hope your wife is already taking Folic acid 5 mg (milligram) daily and has already undergone routine investigations of pregnancy.

Her hemoglobin, urine routine test, TSH (thyroid-stimulating hormone), FBS (fasting blood sugar), Hb electrophoresis, VDRL (venereal disease research laboratory), HIV (human immunodeficiency virus), and HBsAg (hepatitis B surface antigen) are all normal. Also, I hope that the NT (nuchal translucency) and NB (nasal bone) are normal. Please review otherwise. In view of the previous three abortions, please start the tablet Ecosprin 75 mg daily (Aspirin). It will continue till 36 weeks. Also get tested for APLA antiphospholipid antibodies for LAC and ACL. According to the report, we will decide whether further pregnancy support is required or not. Do not take any medication except Folic acid, Ecosprin and Doxinate (a combination of Doxylamine succinate and Pyridoxine hydrochloride for vomiting) till first three months (12 weeks) of pregnancy to avoid congenital malformations in the baby.

Hope I have addressed all of your queries and concerns.

Do follow up whenever needed.

Thank you.

Answer 2

Hello,

Welcome to icliniq.com.

I understand your concern and will definitely help you with it.

Yes, Enoxaparin (Enoxion) should be continued till 36 weeks of pregnancy. ACL and LAC will help us know whether we should continue with 40 IU or increase to 60 IU. Hb electrophoresis is done to detect a genetic defect called thalassemia in individuals. The result can be normal, a carrier, or thalassemia disease. Usually, children with parents being a carrier or thalassemic have a risk of developing thalassemia. The test for your wife is normal, and therefore, you need not worry. Your baby does not have any risk of having thalassemia.

I hope this is clear, and if you have any questions, do not hesitate to ask.

Do follow up whenever needed.

Let me know if I can assist you further.

Thank you.