Prenatal Medical Food Maintains Hemoglobin Levels in Pregnancy

Results of a recent study show that women who take a prenatal medical food containing L-methylfolate, high-dose vitamin B12, and iron (Neevo, NeevoDHA) during pregnancy are able to maintain higher hemoglobin levels than pregnant women taking a standard prenatal vitamin with iron supplementation, folic acid, and lowdose vitamin B12, reported Amy Hermes, RN, WHNP-BC, Gainesville OB/GYN, TX. She reported the findings at the American Society for Reproductive Medicine 2010 Meeting.

The American Congress of Obstetricians and Gynecologists has no specific definition of anemia during pregnancy, but most practitioners define it as a hemoglobin level <11 g/dL. Up to one third of women have hemoglobin levels <11 g/dL sometime in pregnancy.

The prenatal medical food contains iron as well as 1 mg of L-methylfolate (the biologically active form of folate) and 1 μg of methylcobalamin (the active metabolized form of vitamin B12).

“The folic acid in a prenatal vitamin has to be metabolized, and some people are not able to fully metabolize it,” said Ms Hermes.

In this retrospective analysis, Ms Hermes compared the charts of 58 pregnant women who received the prenatal medical food and 54 pregnant women (all aged 21-39 years) who took a standard prenatal vitamin. Baseline hemoglobin levels and other patient characteristics were similar between the 2 groups. Hemoglobin levels were recorded at initiation of prenatal care, at the end of the second trimester, and at delivery.

At the end of the second trimester, mean hemoglobin level was 11.8 g/dL in the group of women taking the prenatal medical food compared with 11.3 g/dL with the standard prenatal vitamin. Mean hemoglobin levels stayed higher in the women taking the prenatal medical food at delivery.

Mean hemoglobin levels dropped 11% from initiation of prenatal care to delivery in women taking a standard prenatal vitamin and 4% in those taking the prenatal medical food.

Anemia developed about half as often by 6 months in the prenatal food group compared with the prenatal vitamin group (39.7% vs 74.1%). Anemia has been linked to possible adverse pregnancy outcomes, such as miscarriage, preeclampsia, early delivery, and low birth weight, Ms Hermes said.

“Hemoglobin levels greater than 11 g/dL are optimal and lessen the need for blood transfusion after delivery and other postpartum complications. It’s possible that if we can reduce the risk of anemia and maintain patients’ hemoglobin levels, we may not have as many of those complications,” she said.

“Standard practice in the past for women who become anemic had been to recheck their blood levels in the second trimester and give them an iron supplement. Our problem with that is that not all women are compliant, because of the gastrointestinal side effects, and it doesn’t work very well if you’re not able to take it. You could still add an iron supplement if they became anemic on the prenatal medical food, but we didn’t find the need to do so,” Ms Hermes said.