Alkem

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Gemcal XT

Retrospective Analysis of the Efficacy and Safety Profile of Combined Calcium Carbonate, Vitamin D3, Methylcobalamin, L-Methyl Folate Calcium, and Pyridoxal-5-phosphate Supplementation during Pregnancy.

Patient No *

Patient Initials *

Date of Enrollment *

Demographic Information

Subject Initials *

Gender *

Male Female

Age (in Years) *

Weight *

Height *

Date of Enrollment *

Medical History *

Presented complaints *

Baseline Characteristics

Maternal Age *

Ethnicity (Insert) *

Parity (Number of previous pregnancies) *

Gestational Age at Initiation of Supplementation (Weeks) *

Pre-pregnancy BMI (kg/m²) *

Maternal Weight Gain during Pregnancy (kg) *

Supplementation Regimen

Combined Supplementation Regimen *

Specify each supplement	Dosage	Frequency	Duration

Compliance Assessment *

Prescription refill records self-reported adherence

Pregnancy Outcomes

1. Incidence of Adverse Pregnancy Outcomes

Preterm Birth *

Yes No

Gestational Hypertension *

Yes No

Gestational Diabetes *

Yes No

Intrauterine Growth Restriction *

Yes No

2. Newborn Characteristics

Birth Weight (grams)*

Gestational Age at Delivery (weeks)*

Apgar Scores (1-minute and 5-minute scores)*

Maternal Health Indicators

1. Blood Pressure

Systolic (mmHg) *

Diastolic (mmHg)*

2. Hemoglobin Levels

Measurement Date *

Result (g/dL)*

3. Urinary Protein

Result *

Negative Trace Positive

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4. Gestational Age at Delivery

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Date *

Result (Weeks)*

5. Mode of Delivery*

Vaginal Cesarean section

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