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CION Cancer Clinics
B12, folate and your pregnancy: what low levels mean | CION Cancer Clinics
Yes, low B12 or folate in pregnancy matters. Your baby draws on both to build its brain, spine and blood, and running low can leave you anaemic and exhausted. Folate is most important before and just after conception; B12 matters throughout pregnancy and breastfeeding, especially on a vegetarian diet. A simple blood test finds it, and your doctor sets the treatment. This page explains risks, tests and warning signs. At CION Cancer Clinics, our haematologist cares for anaemia, bleeding, clotting and inherited blood disorders, with ArogyaSri, CGHS and cashless insurance accepted.
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Medically reviewed by Dr. Basudev PokhrelConsultant Haematologist · last reviewed September 2026, next review due September 2027
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On this page
- Why do B12 and folate matter so much in pregnancy?
- Who runs low on B12 or folate during pregnancy?
- How is a deficiency found and checked?
- What do the words on your blood report mean?
- What do families often get wrong about pregnancy vitamins?
- What happens after the birth, and what can this page not tell you?
- Common questions about B12, folate and pregnancy
The short answer
Why do B12 and folate matter so much in pregnancy?
Your baby builds its brain, spine and blood from your stores of folate and vitamin B12. If either runs low, you can become tired and anaemic (a low haemoglobin, so your blood carries less oxygen), and the baby's early development can be affected.
What folate does in the first weeks
Folate helps close the tube that becomes the baby's brain and spinal cord. This happens very early, often before a woman knows she is pregnant. That is why antenatal guidance, including India's national programme, advises folic acid before you conceive and through early pregnancy. Your doctor or antenatal clinic will tell you which tablet and strength suits you.
What B12 does
B12 works alongside folate to make healthy red cells and to protect the nerves. A baby who is breastfed by a mother with low B12 can also run low, because breast milk carries only what the mother has. Low B12 is common in India, especially in families who eat no meat, fish or eggs.
Why it is easy to miss
Tiredness, breathlessness on the stairs and pale skin are also normal parts of pregnancy. Many women and their families put these down to the pregnancy itself. A blood test is the only way to tell the two apart.
This page explains the condition. It does not replace the plan your obstetrician or haematologist makes for you.Who is more likely
Who runs low on B12 or folate during pregnancy?
Any pregnant woman can. These groups start with smaller reserves or lose them faster, so tell your antenatal doctor if one applies to you.
Vegetarian and vegan diets
B12 comes almost entirely from animal foods. Milk and curd give some, but many vegetarian women in Telangana and Andhra Pradesh enter pregnancy with low stores and never know it.
Severe vomiting
Heavy morning sickness that lasts for weeks limits what you can eat and keep down. Both vitamins can fall quickly in this situation.
Constant vomiting needs your doctor's attention on its own account, whatever your vitamin levels.Twins, close pregnancies
Carrying more than one baby, or becoming pregnant again soon after a previous birth or while still breastfeeding, gives your stores little time to recover.
Health conditions and medicines
Some conditions and medicines lower absorption or raise need. Your doctor may suggest a different folic acid strength or earlier testing.
Mention these at booking
- Epilepsy medicines or metformin
- Diabetes, coeliac disease or past stomach surgery
- A previous baby with a spine or brain defect
- Pernicious anaemia or thalassaemia trait
Not sure whether this applies to you?
Ask an oncologistIn antenatal care
How is a deficiency found and checked?
The booking blood count
Your first antenatal visit usually includes a complete blood count. It shows your haemoglobin and the size of your red cells, called MCV on the report. Large red cells point towards low B12 or folate.
Looking closer
If the count is low, your doctor may order B12, folate and ferritin (your iron store). Low iron is also common in pregnancy and can hide the large cells, so the MCV alone may look normal.
Reading the result for pregnancy
Blood volume rises in pregnancy, which dilutes the B12 level. A borderline result is harder to read than it would be outside pregnancy, and reference ranges differ between laboratories.
Treatment and a repeat test
Your doctor decides between tablets and injections, and repeats the blood count to confirm it is rising. A haematologist is involved when the picture does not fit a simple deficiency.
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When not to wait for the next antenatal visit
If you are pregnant and become breathless at rest, feel your heart racing, have chest pain or faint, go to the nearest emergency department the same day or call 108. Also seek urgent care for a breastfed baby who feeds poorly, is unusually floppy or sleepy, or stops reaching the milestones they had reached. Tell the doctor about your own diet and any low B12 result.
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On your report
What do the words on your blood report mean?
- Macrocytic anaemia
- A low haemoglobin with red cells larger than usual. Low B12 or folate is the commonest cause.
- MCV (mean cell volume)
- The average size of your red cells. A high value suggests large cells, but low iron at the same time can pull it back towards normal.
- Serum B12
- The amount of B12 in your blood. In pregnancy it often reads lower than your true store, so a borderline value needs careful reading.
- Serum or red cell folate
- The amount of folate in your blood. The red cell test reflects the past few weeks rather than your last few meals.
- Ferritin
- Your iron store. It is checked alongside B12 and folate because more than one deficiency is common in pregnancy.
Commonly believed
What do families often get wrong about pregnancy vitamins?
"The tablets from the government clinic are enough, so there is nothing more to check."
Iron and folic acid tablets help many women. They do not contain B12, and they do not fix every cause of a low count. If your haemoglobin stays low despite taking them, ask for further tests.
"Folic acid will fix a B12 problem as well."
Folic acid can lift the blood count while a B12 shortage carries on quietly. The nerves can keep being harmed. This is why doctors check both vitamins before treating a large-cell anaemia.
"Tiredness is just part of pregnancy."
Some tiredness is. Tiredness that stops you managing the day, breathlessness on light effort, or tingling in the hands and feet deserves a blood test rather than patience.
"Taking extra vitamins on your own is always safe."
Doubling tablets or buying injections without advice can hide a problem or mix badly with other medicines. Let your doctor set what you take, and bring every packet to the antenatal visit.
Being straight with you
What happens after the birth, and what can this page not tell you?
A deficiency does not end when the baby arrives. Breastfeeding keeps drawing on your B12, so a mother who was low in pregnancy can stay low for months, and so can her baby. Ask for your blood count to be repeated after delivery if you were treated during pregnancy.
What your baby's doctor needs to know
Tell the paediatrician if you had low B12 or follow a vegetarian or vegan diet. Babies with low B12 may feed poorly, gain weight slowly or seem less alert. These signs have many causes, and a simple test can check.
When a haematologist is involved
Most deficiencies are managed by the obstetrician. A haematologist becomes useful when the count does not rise with treatment, when white cells or platelets are also low, or when pernicious anaemia (the body cannot absorb B12 from food) is suspected. At CION, Dr. Basudev Pokhrel and the haematology team review such reports and coordinate care with your obstetrician.
What this page cannot tell you
It cannot tell you whether your own result is low enough to need treatment, which tablet to take, or how your baby is growing. A single result is read alongside your symptoms, your diet and a repeat test. Only the team that sees all of that can answer for you.
Questions we are asked
Common questions about B12, folate and pregnancy
Can low B12 in pregnancy harm my baby?
It can, which is why it is worth finding and treating. Low B12 has been linked with problems in the baby's early development and, after birth, with poor feeding and slow growth in breastfed babies. Most women who are found and treated go on to have healthy babies. Your doctor will explain what your own result means.
I found out I was pregnant late. Is it too late for folic acid?
Tell your doctor or antenatal clinic straight away rather than worrying alone. Folate still matters for your blood and the baby's growth later in pregnancy. The early scans are designed to check how the baby's spine and brain have formed, and your team will talk you through the findings.
Do the IFA tablets from the anganwadi contain B12?
The standard iron and folic acid tablets given through government antenatal care do not contain B12. They are meant to prevent low iron and low folate. If you are vegetarian, or your blood count stays low while you take them, ask your doctor whether your B12 should be checked.
Are B12 injections safe while pregnant or breastfeeding?
B12 is a vitamin your body needs, and doctors do give it in pregnancy and while breastfeeding when a deficiency is found. Whether you need injections or tablets depends on the cause and how low your level is. Your treating doctor decides this and sets the schedule. Do not start injections on your own.
Can I get enough B12 from food as a vegetarian?
Milk, curd, paneer and eggs, if you eat them, all provide some B12. Plant foods provide almost none unless fortified. Many vegetarian women still run low in pregnancy because the need goes up. Food helps keep a level steady, but a confirmed deficiency usually needs treatment your doctor prescribes.
My haemoglobin is low but my MCV is normal. Can it still be B12?
Yes. If you are also low on iron, the small cells from iron shortage and the large cells from B12 shortage can average out to a normal MCV. That is why doctors often check ferritin, B12 and folate together in pregnancy rather than relying on cell size alone.
Will I need a bone marrow test?
Very rarely. Most deficiencies in pregnancy are clear from blood tests and improve with treatment. A haematologist considers further tests only when the counts do not respond, when other blood cells are also low, or when the picture does not fit. If that is needed, the team will explain why and where it is done.
Should I get my B12 checked before trying for another baby?
If you were low in a past pregnancy, follow a vegetarian or vegan diet, or take metformin or epilepsy medicines, it is a sensible question to raise before you conceive. Your doctor can check your blood count and vitamin levels and advise on folic acid so you start the next pregnancy with fuller stores.
Your Haematologist
Meet CION's haematologist. One specialist for your blood report and your plan.
Dr. Basudev Pokhrel reviews blood counts, transfusion needs and blood disorders, and works with the CION tumour board on blood cancers.
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Sources
- NHS — Vitamins, supplements and nutrition in pregnancy
- NHS — Vitamin B12 or folate deficiency anaemia
- WHO — Anaemia fact sheet
- National Health Mission — National Health Mission, Government of India
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
Related pages
B12 Deficiency in Vegetarian and Vegan DietsWhy vegetarian families run low, and what helpsFolate Deficiency and Who Gets ItThe other vitamin behind large red cellsReading a B12 Result and Borderline ValuesIf your level is only just below the rangeB12 Injections vs TabletsWhat decides which one your doctor choosesB12, Folate and Macrocytic AnaemiaThe full guide to this group of conditions
Talk to us
Low B12 or folate on a pregnancy report?
Tell us what has been found so far. Our haematology team will read the reports with you and work alongside your obstetrician. One helpline serves every CION centre.