Anemia during pregnancy (Anemia)

Anemia during pregnancy is a treatable condition. Symptoms of anemia during pregnancy are weakness and fatigue. Your doctor will measure your blood with a blood test at the first pregnancy exam and advise you on taking iron supplements if necessary. You can prevent anemia during pregnancy by getting at least 27 mg of iron per day from normal foods and supplements.

What is anemia during pregnancy?

Anemia during pregnancy occurs when you have fewer red blood cells in your blood than you should. Red blood cells contain hemoglobin, a protein that carries oxygen from the lungs to other cells of the body. The most common form of anemia is anemia caused by iron deficiency . This means that your body doesn’t have enough iron to help produce red blood cells.

Pregnancy increases your risk of anemia. The World Health Organization (WHO) estimates that one-third of all women of reproductive age and about 40 percent of pregnant women worldwide have anemia.

What causes anemia during pregnancy?

Iron deficiency and increased blood amount with pregnancy are shown as the most likely cause of anemia.

With pregnancy, a woman’s blood volume increases by about 4.5 to 6.5 cups. This is about 30 to 50 percent more than in non-pregnant women. However, your red blood cell volume only increases by 15 to 30 percent. This, in turn, often causes a condition called dilutional anemia (meaning there is more fluid than extra red blood cells). If your body isn’t getting enough iron from what you eat (or supplement), especially at the start of pregnancy, it can easily fall short of providing iron for your increased blood volume.

The following conditions are among the factors that increase anemia during pregnancy :

• Having had heavy menstrual periods before becoming pregnant
• Consuming foods that are not rich in iron
• Consuming foods that are not rich in vitamin C
• Consuming too many foods or beverages that reduce iron absorption (such as tea, coffee)
• Short time between consecutive pregnancies
• Getting pregnant under the age of 20
• Having had a stomach or intestinal disease that affects nutrient absorption
• If you have a disease that increases the risk of anemia, such as hypothyroidism, chronic kidney disease, sickle cell disease, or inherited blood disorders such as thalassemia
• Having undergone certain gastric bypass surgeries that alter the intestines and the absorption of nutrients
• Using medications that affect the way your body absorbs iron from food
• Having lost more blood than usual while giving birth before or having lost a lot of blood for another reason
• Not getting enough folic acid
• Not getting enough vitamin B12
• Multiple pregnancies (twins, triplets..)
• Having a history of anemia before pregnancy
• Severe nausea due to pregnancy

Symptoms of anemia during pregnancy

If you have mild anemia, there may not be any signs of anemia during pregnancy. Sometimes fatigue may be the only symptom you notice. Fatigue during pregnancy is a common condition. Many women don’t even realize that iron deficiency makes them feel more tired than usual.

Fatigue and weakness are the most common symptoms of severe anemia. Other symptoms that may start mildly and develop gradually are:

• Headache
• Dizziness, a feeling of dizziness when you stand up
• Hair loss
• Wants to eat foods that are not food (Pica syndrome)
• Leg cramps and/or an unpleasant urge to move your legs to move when you’re inactive
• Palpitations, rapid heartbeat
• Chest pain
• Irritability or lack of concentration
• Spoon-shaped nails
• Cracks in the corners of the mouth
• Brittle nails
• Blue color in the white part of the eye
• Pale skin. Pale lips, inner eyelids, and inside the mouth
• Dyspnea
• Throat or inflamed tongue
• Mouth ulcers

How is anemia diagnosed during pregnancy?

At your first checkup , your doctor will evaluate your medical history, physically examine you, and perform standard blood tests, including checking for anemia. Even if you don’t have anemia at the beginning of your pregnancy, you are at risk of becoming anemic as your pregnancy progresses. Your doctor will re-examine your anemia condition with a blood test at the beginning of the second trimester.

One of the blood tests you will have is a complete blood count. With a complete blood count, the following values are measured:

• The percentage of red blood cells in your bloodstream (hematocrit or Hct)
• The amount of hemoglobin in these red blood cells (Hgb or Hb)
• MCV or Mean Corpuscular Volume. This can help distinguish between types of anemia. For example, a low MCV is indicative of iron deficiency anemia, while a high MCV indicates anemia caused by a B12 or folate deficiency. And a normal MCV with anemia can mean dilutional anemia or thalassemia (a genetic cause of anemia).

Blood test results

The WHO (World Health Organization) defines anemia in pregnancy as:

• First trimester: The hemoglobin (Hgb) level is less than 11 grams (g) of hemoglobin per deciliter (dL) of blood and less than 33 percent of hematocrit (Hct).
• Second trimester: Hgb <10.5 g/dL, approximately hematocrit <31 or 32 percent
• Last trimester: Hgb <with approx. 33 percent of hematocrit <10.5 to 11 g/dL
• Postpartum: Hemoglobin 10g/dL, hematocrit < about 30 percent

Does anemia during pregnancy harm the baby?

Mild anemia during pregnancy is very common, it is observed. It’s easy to treat and there’s usually nothing to worry about.

If you have untreated and ongoing or severe anemia, it can cause problems for you and your baby. Severe anemia in pregnancy (especially in the first two trimesters) can increase the risk of:

• Premature birth,
• The baby is born with less weight than normal,
• To the baby whose development is retarded according to the gestational week,
• Postpartum depression,
• Complications from blood loss during childbirth, (You’re not more likely to lose blood, but you may be more likely to need a blood transfusion or feel weak.)
• Stillbirth and neonatal death,

Severe anemia may put your baby at higher risk for anemia in infancy.

Animal studies have shown that iron plays an important role in brain development, and the developing fetus doesn’t get iron first if you have an iron deficiency. And some human observational studies have linked maternal anemia in infants and children to mental problems and neurodevelopmental disorders such as autism spectrum disorder, attention-deficit/hyperactivity disorder, and intellectual disability.

Treatment of anemia during pregnancy

Anemia caused by iron deficiency is usually easy to treat with iron supplements. (You may need to take iron supplements, as it will be difficult to get enough iron from what you eat alone.)

If you take the iron supplements that your doctor will prescribe for iron supplementation at the recommended doses and times, your anemia will go away. (You’ll probably be advised to take these in addition to your prenatal vitamins .)

The National Institutes of Health describes the minimum amount of iron that women should take daily as follows:

• 14-18 years old 15 mg
• 18 mg for 19 to 50-year-olds
• 27 mg during pregnancy

Note: Check the iron supplement label for the amount of elemental iron; This indicates the amount your body can absorb. This amount of mg is not the same as the number of mg for ferrous gluconate or ferrous sulfate (sources used for iron supplements), which also appears on the label.

If you have anemia, you need to take more than 27 mg of iron per day, which we mentioned above.

Don’t forget to tell your doctor about any other medications you’re taking. That’s because some of these may interact with iron supplementation. (You may need to change the types of medications, or your doctor can tell you how to take them.)

To increase iron absorption;

• Iron is best absorbed on an empty stomach, but many women cannot easily tolerate iron supplements. (They can cause nausea, cramping, and diarrhea in some women.)
• Take your iron supplements with a vitamin C, as vitamin C helps with iron absorption. Orange juice is a good source of vitamin C, but it causes heartburn for many pregnant women. Some iron supplements — usually prescription varieties or liquid varieties — already contain that extra vitamin C.
• Avoid dairy, spinach, caffeine, soy products, and whole-grain breads and cereals an hour before and two hours after taking your iron supplements. All of these foods can reduce iron absorption.
• Don’t take antacids or calcium supplements at the same time as your iron supplements. Take them an hour or two apart.
• If the iron supplement makes you nauseous, try taking it right before bed.
• If you’re having trouble taking iron supplements, you can try taking smaller amounts throughout the day. Or you can talk to your doctor about trying another type of iron supplement. There are countless standard pill options, as well as gummy and liquid formulas. Prescription iron supplements are sometimes easier to tolerate but can be expensive. If you can’t take oral iron supplements, iron infusions are also available.
• To prevent constipation (a common side effect of iron supplements), drink plenty of water, exercise regularly, and consider adding prunes or prune juice to your diet. Stool softeners, such as docusat sodium, are safe and are often taken for constipation during pregnancy. Ask your doctor for a recommendation.
• If you’re taking liquid iron supplements, mix the liquid with water or juice and drink through a straw to prevent staining your teeth.
• Store iron tablets in a cool, dry place (or they may crumble). Be sure to keep it out of the reach of children.
• Call your doctor if you have tarry-looking or red-streaked stools (black stools are normal when taking iron supplements).