Pernicious Anaemia Society
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Pregnant and b12 88

Hi everyone,

So to give you a background on my situation.... I'm 33 weeks pregnant. I have been vegan for over a year and have always supplemented b12 through sublingual tablets (which to be fair I was a bit crap at remembering to take) but also through fortified foods. I just found out my b12 level is 88.

My iron is also slightly low but I was having what my midwife referred to as classic anaemia symptoms. I get very short of breath, dizzy, severe heart palpitations I also get this dull ache down both arms. These symptoms seem to happen in sort of attacks - I'll feel ok one minute and then these symptoms come on in sort of waves and the only thing that really relieves it is sitting if standing or if it happens when I'm already sitting then lying down.

I was really disappointed in the service of my hospital as my midwife suggested b12 to be tested as my symptoms seemed very severe for only a slight drop in iron.... When I requested at the hospital they refused (even though I explained my symptoms and that I was vegan) saying it was unnecessary. Luckily I have a good GP who immediately ran my b12 levels. If I would have been less assertive I would have gone on to breastfeed my baby and she would also have been b12 deficient causing health implications for her.

From what I understand 88 is very low. I have been put on every other day injections for two weeks by my GP. Does anyone think I should be supplementing on top of the injections? How effective are the injections? Basically I want to know how long it will be until I start to feel better? I'm really emotional (read: hormonal) and find it really upsetting and frustrating every time I get an attack. I can't wait to feel better for myself and my baby.

Does anyone have any advice on the questions above?

By the way I have also introduced eggs and dairy back into my diet since diagnosis.

Thanks for reading,

Hannah (and bump) X


9 Replies

given that you supplement a dietary B12 deficiency is extremely unlikely - so sounds like you have an absorption problem. Reintroducing things back into your diet is unlikely to have any impact - so hoping the injections do the trick - you definitely need plenty of B12 if you are pregnant so a big thumbs up to the mid-wife.

You also need to keep an eye on your folate levels as processing B12 needs folate but would expect those to be monitored as impact of folate in pregnancy is pretty much up the agenda of most medics.

Suggest you ask your GP outright if you blood results showed any signs of macrocytosis - the most common form of anaemia associated with a B12 deficiency - it is possible that the symptoms you have are down to the anaemia in which case you will be in for a bit of a wait as it usually takes a couple of months for the body to replace red blood cells that are causing the problem - happens as the old ones die and are replaced with new healthy ones.

You may find it useful to try and establish exactly what the full range of your symptoms are and keep a diary of what is going on - many people notice a difference in energy levels in 2 weeks but it depends on the exact mechanism that is causing the energy dip or whichever symptom

check list of symptoms can be found here


And if you have any neuro symptoms then the BCSH and NICE guidelines are for loading shots to continue until symptoms stop improving - with reviews at 3 weeks.

I believe it is possible for a B12 deficiency to be related to pregnancy - similar to gestational diabetes - but also think it is quite rare.


Hiya thanks for the reply,

My GP said he was actually surprised to see that my blood cells were not enlarged. He said his gut feeling is the deficiency is pregnancy related because of this - if it was a long term absorption issue he would expect to see the enlarged blood cells.

I forgot to say I'm also supplementing iron and folic acid - my iron levels have gone from 105 to 103 and my last test was 107 so looks like there's some improvement being made there but my symptoms are still getting worse.

Here's hoping injections work quickly.

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Ask to get intrinsic factor checked to see if pernicious anaemia (50% sensitive so missed half true cases though). Your B12 deficiency may be pregnancy related but more likely absorption if you have only been vegan a year. It takes quite a long time for B12 levels to drop e.g. I have read about 6 years after gastric bypass surgery. One test which is supposed to better in pregnancy is active B12 but if you have started supplements then it will be pointless.

Some people start feeling better soon after injections. I felt more human and others noticed a change after a couple of jabs but it took about 2 months for most symptoms to resolve ie neuro symptoms.

If you have any neuro symptoms then the protocol is alternate day injections until no further improvement (NICE guidelines). It took 2 months of this to help me. Everyone is different though. A lot of people supplement with sublingual tablets. I take 5mg Jarrows or Solgar methylcobalamin.

Also were you actually anaemic? If so, you need to check potassium levels are ok when supplementing B12 as these can drop as new blood cells are made.

Having large blood cells is often caused by B12 or folate deficiency but 25% people with these deficiencies never get macrocytosis so it does not mean anything if your red cells are not enlarged. I never had enlarged cells. Centre for disease control reports that there is an inverse relationship between anaemia and neuro problems with B12 def and it is not understood why some people get anaemia and others don't.

Good luck to you and bump. My understanding is that B12 deficit is potentially dangerous to babies so it is good that you are getting treated by your GP, but consider discussion with them about getting more if you have neuro symptoms.


macrocytosis is a symptom not a defining characteristic - about 30% of people with absorption problems present with other symptoms first but the number of GPs that are aware of this is quite small and most are hopelessly confused about how a B12 deficiency works - which isn't that surprising when you think about the guidelines that are out there which tend to focus on it as a blood disorder. I can trace my symptoms back over 40+ years but I've never had any signs of anaemia.

Really hope that it is gestational but if it doesn't seem to clear up after the pregnancy then do come back to the forum.

Personally I wouldn't go for lots of investigations into the cause at this point but wait and see what happens as your GP is doing. The tests for PA are notoriously inaccurate and as I may already have said the treatment would be the same whatever the cause.

as secondchance says below B12 is very important for the baby as it is a vitamin that is used in cell reproduction.

hope it all goes well.


Hi Hannahroobs. Can't really add anything to the excellent advice already given by Gambit62 but just wanted to say hope you begin to feel better very soon.

The 'pick-up' and recovery rate does very from I dividual to individual so please don't be disheartened. You just need to make sure that you get enough B12 to make your feel well!

As Gambit says, if you have neurological symptoms you should have injections every other day until there is not further improvement, and then injections every other week.

Without neurological symptoms, the treatment is six loading doses (one every other day) and the injections every three months (although please be aware that this is not enough for some people to be and keep well).

The golden rule is that your GP should be treating your symptoms.

There are lots of very knowledgable people here so please do come back if you need any more help or advice.

Finally, the very best of luck with your immanent birth. Exciting times😀.


if you have microcytosis it can mask macrocytosis (don't think lve spelt those right) never mind, 25% of those with p.a apparently do not have enlarged red blood cells, tests to confirm as far as I'm aware are intrinsic factor mma and homocysteine but possibly best to wait if your pregnant until your body settles down after the birth if your iron count is low ask for your ferritin levels to be checked as my levels were 112 range (115-150) but my ferritin was seriously low at 6, 6 months after l had my second child l was diagnosed post natal depression l didn't ever have bloods taken for these so important nutrients, l now 15 years later am starting to discover multiple deficiencies after numerous tests and believe more to come, post natal checks in my view should include routine bloods for all the nutrients that are sapped from your body during pregnancy and beyond, check vitamin d too it really is a great little tablet, don't be afraid to ask for levels of everything and ranges and good luck!

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There is a book about children and B12 in the above link. Check out the videos under the heading Films too.

Wishing you well t this special time ....

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For 7

years I was experiencing off and on, hands and feet tingling, burning, pain, difficulty walking, extreme fatigue and depression. Countless visits to the ER and Dr. Office,checking for everything but B12. It then started where I had extreme difficulty getting dressed, had trouble feeding myself, could not write or hold a pen. Bending my neck sent electric shocks thru my body. Went to the hospital for MS testing. MRI, spinal tap,Lyme,brain scan. After more testing, one Dr. checked my B12 level, it was 80. I spent 10 days in the u and 10 days in rehab. They were not sure if I would recover. U untreated, B12 deficiency can cause permanent brain damage. I was lucky, everything reversed. Maybe if B12 methylcobalamin supplements were given early on, we might be able to prevent MS and other brain and nerve related diseases.

If that one Dr. didn't check my B12 level,I would have been diagnosed with MS, because the symptoms are the same.

B12 is vital for our health. It helps make DNA & RNA, your red blood cells.

Helps with Depression,Dementia,Sleep Disorders.

Protects &a rebuilds the Myelin sheath covering your nerve fibers.

Slows brain shrinkage up to 80%.

Lowers Homocysteine levels associated with heart disease.

If low levels are left unchecked, brain damage will occur and can become permanent.

Helps with age related macular degeneration.

By supplementing with sublingual Methylcobalmin B12 around 40 or 50 years of age, we could help prevent problems before they start.

Everyone should supplement and maintain blood levels of B12 in the range from 600 to 2000 pg/ml in order to avoid and, if this is the case, help recover from the wide range of problems that result from B12 deficiency or insufficiency. Health care practitioners: this is the first thing you should check for every patient that comes in, independently of their age or condition

Methylcobalamin: This is the neurologically active form of B12. It is technically a `coenzyme` of vitamin B12 and it is almost never prescribed by doctors despite being effective, readily available and inexpensive. It is also available in an injectable form. Degenerative neurological conditions are where methylcobalamin shows its greatest benefits over other cobalamin preparations. Brilliant news for MS’ers! Not only has Methylcobalamin been shown to work in neurologic diseases, it also helps with the elimination of toxic substances in

the body.

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Thank you so much for taking the time to respond all of you, :-) much appreciated


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