Anaemia in Pregnancy

Anaemia in pregnancy means your blood has a lower-than-normal amount of haemoglobin (Hb), which is the protein in red blood cells that carries oxygen. This reduces your blood's ability to carry oxygen throughout your body and to your baby. It's common for haemoglobin levels to naturally drop a little during pregnancy due to an increase in blood plasma volume, a process called physiological haemodilution. However, true anaemia occurs when your haemoglobin falls below specific levels, which can vary slightly depending on the trimester and medical guidelines.

Symptoms

Feeling unusually tired, weak, or lacking energy
Shortness of breath, especially with activity
Dizziness or light-headedness
Pale skin, lips, or nail beds
Headaches
Rapid or pounding heartbeat (palpitations)
Cravings for non-food items like ice, clay, or starch (pica)
Sore or swollen tongue
Cracks at the corners of your mouth
Brittle or spoon-shaped nails
Restless legs syndrome
Severe shortness of breath at rest
Chest pain
Fainting or feeling like you might faint
Significant swelling in your legs or persistent rapid heartbeat

Causes & Risk Factors

Iron deficiency (most common, due to increased needs for mother and baby)
Folate deficiency
Vitamin B12 deficiency
Genetic blood disorders like sickle cell disease or thalassaemia
Chronic illnesses or infections
Blood loss (e.g., from bleeding during pregnancy or gastrointestinal issues)
Conditions where red blood cells are destroyed too quickly (haemolytic anaemia)
Rare bone marrow problems
Not getting enough iron in your diet
Following a vegetarian or vegan diet
Having pregnancies close together (less than 1-2 years apart)
Heavy menstrual bleeding before pregnancy
Having anaemia before becoming pregnant
Carrying multiple babies (e.g., twins or triplets)
Having had many previous pregnancies
Being an adolescent when pregnant
Having had bariatric surgery
Gastrointestinal conditions that affect nutrient absorption (e.g., Crohn's disease, celiac disease)
Certain ethnic backgrounds (e.g., African, South Asian) which may have a higher risk of genetic blood disorders
Genetic blood disorders (e.g., sickle cell trait/disease, thalassaemia)
Low socioeconomic status
Chronic infections or inflammation

Diagnosis

Reviewing your medical history, including diet, previous pregnancies, and any family history of anaemia
A physical examination to check for signs like pale skin or a rapid heartbeat
Blood tests, including a Complete Blood Count (CBC) to measure your haemoglobin levels
Further blood tests, such as iron studies (e.g., serum ferritin) to check your iron stores, if anaemia is detected
Additional tests like vitamin B12 and folate levels or haemoglobin electrophoresis may be done if other causes are suspected
Diagnosis is confirmed when your haemoglobin level falls below specific thresholds for your trimester, as defined by medical guidelines.

Treatment Options

Eating a diet rich in iron, including red meat, poultry, fish, lentils, beans, and fortified cereals
Consuming foods high in Vitamin C (like citrus fruits) with iron-rich meals to help absorption
Taking oral iron supplements, usually 100-200 mg of elemental iron daily, as prescribed by your doctor
Managing side effects of oral iron like constipation or nausea by adjusting dose or timing, or trying different formulations
Receiving intravenous (IV) iron infusions if you cannot tolerate oral iron, have severe anaemia, or need a rapid increase in iron levels
Blood transfusions in severe, symptomatic cases or with significant acute blood loss
Supplementation with folic acid or Vitamin B12 if those deficiencies are identified
Treating any underlying chronic conditions or genetic blood disorders
Regular follow-up blood tests to monitor your haemoglobin levels and ensure treatment is effective
Continuing iron therapy for several months after your haemoglobin levels return to normal, and for at least 6 weeks after delivery, to rebuild iron stores
Referral to a specialist for severe anaemia or if treatment is not effective

Frequently Asked Questions

What haemoglobin level is considered anaemic in pregnancy?

The haemoglobin (Hb) level considered anaemic varies by trimester and medical guidelines. Generally, it's defined as Hb below 11.0 g/dL in the first and third trimesters, and below 10.5 g/dL in the second trimester. Severe anaemia is typically defined as Hb below 7.0 g/dL.

Why is anaemia so common during pregnancy?

Anaemia is common in pregnancy because your body's need for iron increases significantly to support your expanding blood volume, the growth of your baby, and the placenta. Often, dietary intake and pre-pregnancy iron stores are not enough to meet these increased demands. Additionally, a normal physiological increase in blood plasma volume during pregnancy can dilute your blood, leading to a relative drop in haemoglobin levels.

What are the most common symptoms of anaemia in pregnancy?

The most common symptoms include feeling very tired or lethargic, weakness, shortness of breath with activity, dizziness, pale skin, and headaches. Sometimes, symptoms can be mild or mistaken for normal pregnancy discomforts.

Is it possible to be anaemic and have no symptoms?

Yes, it is possible to have mild anaemia and experience no noticeable symptoms, or for symptoms to be so mild that they are attributed to normal pregnancy discomforts. This is why routine screening blood tests are important.

How is anaemia in pregnancy diagnosed?

Anaemia is diagnosed through blood tests, primarily a Complete Blood Count (CBC) to measure your haemoglobin levels. If anaemia is detected, further tests like iron studies (e.g., serum ferritin) will be done to determine the cause, most commonly iron deficiency. Your doctor will also consider your medical history and perform a physical examination.

What are the risks of untreated anaemia for my health?

Untreated anaemia can increase your risk of infections, preeclampsia, postpartum haemorrhage (heavy bleeding after birth), and in severe cases, heart problems. It can also lead to impaired physical and mental performance and an increased risk of postpartum depression.

What are the risks of untreated anaemia for my baby's health?

Untreated anaemia can increase the risk of your baby having restricted growth, low birth weight, being born prematurely, and having low Apgar scores. There's also an increased risk of neonatal anaemia and iron deficiency in the first year of life, and potential long-term effects on their development.

What is the best way to increase my iron levels through diet?

To increase iron levels through diet, focus on iron-rich foods. Heme iron, found in red meat, poultry, and fish, is absorbed best. Non-heme iron sources include lentils, beans, tofu, spinach, kale, and fortified cereals. Eating foods rich in Vitamin C (like citrus fruits or bell peppers) with your iron-rich meals can help your body absorb iron better. It's also advisable to avoid consuming iron with calcium (dairy), phytates (grains, legumes), and polyphenols (tea, coffee) as these can inhibit absorption.

What specific foods are highest in iron?

Foods highest in iron include red meat, poultry, fish (heme iron), and plant-based sources like lentils, beans, tofu, spinach, kale, and fortified cereals (non-heme iron).

Should I take an iron supplement even if my blood tests are normal?

Recommendations vary. Some guidelines, like those from ACOG and WHO, suggest universal low-dose iron supplementation for all pregnant women. Other guidelines, such as NICE, recommend against routine supplementation and advise treating only if anaemia is detected through screening. It's best to discuss this with your healthcare provider to determine what is right for you.

What are the common side effects of oral iron supplements?

Common side effects of oral iron supplements include nausea, constipation, diarrhoea, and abdominal pain.

How can I manage the constipation and stomach upset from iron pills?

You can try taking iron supplements with food, though this might slightly reduce absorption. Lowering the dose, changing the type of iron supplement, or trying alternate-day dosing may also help. Discuss these options with your doctor.

Is one brand or type of iron supplement better than another?

Different formulations of iron supplements, such as ferrous sulfate, ferrous fumarate, and ferrous gluconate, are available. Your doctor can recommend the most suitable type for you, considering absorption and potential side effects. Emerging evidence suggests alternate-day dosing might improve absorption and reduce side effects.

What are the options if I cannot tolerate oral iron supplements?

If you cannot tolerate oral iron supplements due to side effects, or if they are not effective, your doctor may recommend intravenous (IV) iron infusions. This involves receiving iron directly into your bloodstream.

What is an IV iron infusion and why might I need one?

An IV iron infusion is a procedure where iron is delivered directly into your vein through a drip. You might need one if you cannot tolerate oral iron supplements, if your body doesn't absorb iron well, if you have severe anaemia, or if you are late in pregnancy and need to raise your iron levels quickly.

How quickly will my anaemia improve after starting treatment?

With effective treatment, your haemoglobin levels typically begin to rise within 2-4 weeks of starting therapy. Your doctor will monitor your progress with follow-up blood tests.

How often will my blood be checked for anaemia during my pregnancy?

Most guidelines recommend screening for anaemia with a blood test at your first prenatal visit and again around 24 to 28 weeks of gestation. If you are diagnosed with anaemia, your blood will be checked more frequently to monitor your response to treatment.

Does having anaemia increase my risk of bleeding heavily during delivery?

Yes, anaemia in pregnancy is associated with an increased risk of postpartum haemorrhage (PPH), which is heavy bleeding after delivery.

Will I need a blood transfusion because of my anaemia?

Blood transfusions are typically reserved for severe, symptomatic anaemia (e.g., haemoglobin below 7.0 g/dL with signs of heart or breathing problems), acute significant bleeding, or when delivery is imminent and there isn't enough time for iron therapy to work. Most cases of anaemia in pregnancy can be managed with iron supplementation.

Will I still be anaemic after my baby is born?

It's possible to still be anaemic after delivery, especially if your iron stores were significantly depleted during pregnancy. It's important to continue monitoring and treatment postpartum to replenish your iron levels.

How long should I continue taking iron supplements after delivery?

It is generally recommended to continue iron therapy for at least 6 weeks postpartum, and often for at least 3 months after your anaemia has resolved, to fully replenish your body's iron stores.

Can anaemia affect my ability to breastfeed or my milk supply?

The dossier states that postpartum iron supplementation is crucial to rebuild maternal stores and support lactation. While the direct impact on breastfeeding ability or milk supply is not detailed, ensuring adequate iron levels is important for your overall health during this period.

What can I do to prevent anaemia in my next pregnancy?

To prevent anaemia in future pregnancies, focus on maintaining an iron-rich diet, taking recommended iron and folic acid supplements before and during pregnancy, and allowing adequate time (at least 1-2 years) between pregnancies to allow your body to replenish nutrient stores. Regular screening for anaemia is also important for early detection and treatment.