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Macrocytic anemia of pregnancy

Last edited: 4/10/2026

Overview

Macrocytic anemia is defined as a mean corpuscular volume (MCV) greater than 100 fL. In pregnancy, macrocytic anemia can be caused by vitamin B12 or folate deficiency, or by other causes such as liver disease, hypothyroidism, or alcohol use 1.

Diagnosis

  • Macrocytic anemia is defined by a mean corpuscular volume (MCV) > 100 fL 1.
  • Evaluation should include a peripheral blood smear to assess red blood cell morphology and a reticulocyte count 1.
  • Serum vitamin B12 and folate levels should be measured 1.
  • Consider testing for other causes of macrocytosis, such as liver function tests, thyroid function tests, and alcohol use assessment 1.

    • Management

  • Treatment of macrocytic anemia in pregnancy depends on the underlying cause 1.
  • For vitamin B12 deficiency, supplementation with cyanocobalamin or hydroxocobalamin is recommended 1.
  • For folate deficiency, supplementation with folic acid is recommended 1.
  • Management of other causes of macrocytosis should address the specific underlying condition 1.

    • Special Populations

  • Pregnancy: Macrocytic anemia can have implications for both maternal and fetal health 1.

    • Key Recommendations

  • Macrocytic anemia is defined by a mean corpuscular volume (MCV) greater than 100 fL 1. (Evidence: Expert opinion)
  • Evaluation should include a peripheral blood smear, reticulocyte count, serum vitamin B12, and folate levels 1. (Evidence: Expert opinion)
  • Treatment should be directed at the underlying cause of macrocytic anemia 1. (Evidence: Expert opinion)

    • References

    1 . Macrosomia: ACOG Practice Bulletin, Number 216. Obstetrics and gynecology 2020. link

    Original source

    1. [1]
      Macrosomia: ACOG Practice Bulletin, Number 216. Obstetrics and gynecology (2020)
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