Anemia during pregnancy is frequently encountered but manageable. You can take steps to avoid anemia during pregnancy by ensuring a daily intake of at least 27 mg of iron from both your diet and food supplements.
What does anemia during pregnancy involve?
Anemia refers to a condition where your blood has fewer red blood cells than necessary. These cells carry hemoglobin, a protein crucial for transporting oxygen from your lungs to cells throughout your body. The most common type of anemia is iron deficiency anemia (IDA), indicating insufficient iron levels to support the production of red blood cells.
Pregnancy heightens the risk of developing anemia. The World Health Organization (WHO) estimates that approximately one-third of women of reproductive age and 40 percent of pregnant women globally experience anemia.
What are the causes of anemia in pregnancy?
Anemia in pregnancy often results from a combination of factors, primarily the expansion of blood volume alongside insufficient iron levels and intake.
During pregnancy, blood volume increases by approximately 4 1/2 to 6 1/2 cups, a surge of 30 to 50 percent compared to non-pregnant women. However, the increase in red blood cell volume is only around 15 to 30 percent, leading to dilutional anemia, where there is an excess of fluid relative to red blood cells. This imbalance often occurs due to inadequate iron supply for the expanding blood volume, particularly if iron intake from diet or supplementation was insufficient before pregnancy.
Apart from the inherent risks associated with pregnancy, several factors can heighten the likelihood of anemia during gestation:
- Previously experienced heavy menstrual periods before conception
- Consumption of a diet lacking in iron-rich foods
- Consumption of a diet lacking in vitamin C-rich foods, which aid iron absorption. (You can also opt vitamin c supplements in its substitute)
- Overconsumption of foods or beverages that inhibit iron absorption, such as dairy products, soy-containing foods, coffee, and tea
- Short intervals between pregnancies
- Pregnancy at a young age (under 20)
- Presence of stomach or intestinal conditions affecting nutrient absorption
- Underlying medical conditions increasing the risk of anemia, such as hypothyroidism, chronic kidney disease, or inherited blood disorders like sickle cell disease or thalassemia
- History of specific gastric bypass surgeries altering nutrient absorption
- Use of medications impacting iron absorption from food
- Previous experiences of excessive blood loss during childbirth or other events
- Inadequate intake of folic acid or vitamin B12
- Pregnancy with multiple fetuses
- Past history of anemia prior to pregnancy
- Experience or history of morning sickness, potentially hindering the intake of prenatal vitamins and iron supplements, or limiting the consumption of iron-rich foods.
Symptoms of Anemia During Pregnancy
Anemia symptoms may not always be apparent, particularly if the condition is mild. Fatigue, often attributed to reduced oxygen circulation, is a common symptom, and many pregnant individuals may attribute it to typical pregnancy tiredness without recognizing the underlying iron deficiency.
Severe anemia typically manifests as pronounced fatigue and weakness. Additional symptoms, which may initially be mild and progress gradually, include:
- Headaches
- Dizziness or lightheadedness upon standing
- Hair loss
- Cravings for non-food items (pica) or a desire to chew on ice
- Leg cramps or restless legs syndrome
- Palpitations or rapid heartbeat
- Chest pain
- Irritability or difficulty concentrating
- Spoon-shaped nails
- Glossy tongue
- Cracks in the corners of the mouth
- Brittle nails
- Bluish tinge in the whites of the eyes
- Pale complexion, including lips, inner eyelids, and mouth lining
- Shortness of breath
- Sore or inflamed tongue
- Mouth ulcers
How is anemia diagnosed during pregnancy?
During your initial prenatal visit, your healthcare provider will review your medical history, conduct a physical examination, and perform routine blood tests, including screening for anemia. Even if you are not anemic at the beginning of your pregnancy, there is a possibility of developing anemia as your pregnancy progresses. Most providers typically retest for anemia during the third trimester.
One of the blood tests you will undergo is a complete blood count (CBC), which includes measurements such as:
- The percentage of red blood cells in your bloodstream (hematocrit or Hct)
- The amount of hemoglobin (Hgb or Hb) present in those red blood cells
- Mean Corpuscular Volume (MCV), which aids in distinguishing between different types of anemia. For instance, a low MCV indicates iron deficiency anemia, whereas a high MCV suggests anemia resulting from a deficiency in vitamin B12 or folate. A normal MCV alongside anemia may indicate dilutional anemia or thalassemia, a genetic form of anemia.
Your healthcare provider may conduct additional tests following the CBC to determine if iron deficiency is the underlying cause of your anemia.
Severe anemia can also put your baby at higher risk for anemia in infancy. Iron is really important for a baby's brain to develop properly. If you don't have enough iron, your baby might not get all the iron they need while they're growing inside you. Some studies with people have also found that when moms have anemia during pregnancy, their babies might have trouble with thinking and learning later on. This can include problems like autism, ADHD, and trouble with understanding things.
Treating Anemia During Pregnancy
Iron deficiency anemia in pregnancy is typically straightforward to manage through iron supplements. (It can be challenging to obtain sufficient iron solely from your diet if you are anemic.)
If your healthcare provider recommends iron supplements and you take them as directed, your condition is likely to improve. (You may be advised to take them alongside your prenatal vitamins.) According to the National Institutes of Health, women should aim for the following daily elemental iron intake:
- 15 mg for individuals aged 14 to 18
- 18 mg for those aged 19 to 50
- 27 mg during pregnancy
Tips For Managing Your Iron Supplement Intake
- Store iron tablets in a cool, dry place to prevent crumbling, and keep them out of reach of children.
- Iron is absorbed most effectively on an empty stomach, but many women experience difficulty tolerating iron supplements. (These supplements can cause nausea, cramping, and diarrhea in some women.) Therefore, you might find it helpful to take your supplement with a small snack.
- Avoid consuming dairy products, spinach, caffeine, soy products, and whole grain breads and cereals for one hour before and two hours after taking your iron supplements, as these foods can reduce iron absorption.
- Do not take antacids or calcium supplements at the same time as your iron supplements. Space them out by an hour or two.
- If nausea occurs, try taking your supplements before bedtime. This may minimize discomfort while you sleep.
- To prevent constipation, a common side effect of iron supplements, ensure you stay hydrated, engage in regular exercise, and consider incorporating prunes or prune juice into your diet. Stool softeners like docusate sodium are safe for use during pregnancy and can be recommended by your provider.
- Contact your healthcare provider if you notice tarry-looking stools or stools with red streaks (black stools are normal when taking iron supplements).
- When consuming liquid iron supplements, dilute the liquid with water or juice and use a straw to prevent teeth staining.
- Pair your iron supplements with a source of vitamin C, as it enhances iron absorption. While orange juice is a good option, it may cause heartburn for many pregnant women. Some iron supplements, typically prescription or liquid varieties, already contain added vitamin C. If yours does not, consider taking a separate vitamin C supplement simultaneously.
- If you struggle to keep down your iron supplements, consider dividing your doses throughout the day or discussing alternative forms of iron with your healthcare provider. Gummy and liquid formulas are available in addition to standard pill options. Although prescription iron supplements may be easier to tolerate, they can be costly. If oral supplements are not viable, iron infusions are an alternative.
Is It Possible To Prevent Anemia During Pregnancy?
There are steps you can take to lower your risk of developing anemia while pregnant.
- Ensure your diet includes rich sources of iron. Maintaining adequate iron levels is key to preventing anemia during pregnancy. Heme iron, found in animal-based foods, is more easily absorbed by your body compared to non-heme iron from sources like legumes, vegetables, and grains. Cooking food in cast iron pans can also increase your iron intake, as some of the iron from the pan is absorbed by the food.
- Include lean red meats, iron-fortified cereals, eggs, peanuts, and beans in your diet as they are excellent sources of iron. Additionally, incorporate foods that enhance iron absorption, such as orange juice, strawberries, broccoli, grapefruit, and peppers.
- Take supplements. Start taking a prenatal vitamin before and during pregnancy, and continue while breastfeeding. If your prenatal vitamin does not contain sufficient iron, consider taking a separate iron supplement to ensure you are consuming at least 27 mg of iron daily. (Refer to the above tips on taking iron supplements.)
- Inform your healthcare provider of your medical history. Disclose any previous diagnosis of iron-deficiency anemia before pregnancy or if you had anemia during a previous pregnancy. Also, inform them of any previous diagnosis or family history of thalassemia. If you have this genetic condition, extra iron intake will not alleviate your anemia.
- By providing your complete medical history, your healthcare provider can effectively manage your condition and provide appropriate treatment during preconception, throughout your pregnancy, and postpartum.
