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Anemia in Pregnancy

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Anemia in Pregnancy

Definition

Anemia is a low level of healthy red blood cells (RBC). RBCs carry oxygen from the lungs to the rest of the body. When red blood cells are low the body does not get enough oxygen. This can cause symptoms such as fatigue, pale skin, or irregular heartbeat.
Liquid blood and plasma increases by about 50% during pregnancy but RBCs only increase by about 30%. This imbalance may lead to anemia.
Red Blood Cells
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Causes

The most common cause of anemia in pregnancy is a low level of iron. Iron is the mineral that makes hemoglobin. During pregnancy, your iron requirements increase from 15 mg (milligrams) per day to 30 mg per day as your blood volume increases. The total iron requirement during pregnancy is 1,000 mg. If this need is not met or if your iron stores are low, you may develop anemia.
Other less common causes of anemia in pregnancy include:
  • Deficiency of folic acid or vitamin B12, the vitamins that produce red blood cells
  • Loss of blood due to injury, bleeding ulcer , or bleeding hemorrhoids
  • Hemoglobinopathies (abnormalities in the genes for the hemoglobin protein that results in less or poorly functioning hemoglobin)

Risk Factors

Factors that can increase your chance of getting anemia in pregnancy include:
  • Anemia before pregnancy
  • Very heavy menstrual flow before pregnancy
  • Morning sickness with frequent vomiting
  • Pregnancies that are close together
  • Carrying twins or multiples
  • A diet that is low in iron
  • Abnormal hemoglobins (more common in individuals of African, Mediterranean, Southeast Asian, or West Indian ethnicity or descent)
If you have any of these risk factors, tell your doctor.

Symptoms

Anemia might not cause any symptoms. If symptoms do occur they may include the following:
  • Weakness
  • Fatigue
  • Dizzy spells
  • Pale skin, especially the palms of the hands, lips, nails, and eyelids
  • Rapid heartbeat
  • Irregular heartbeat
  • Shortness of breath
  • Cravings for non-food items (a condition called “pica”) like clay , ice, and paper

Diagnosis

Your practitioner will test your blood for anemia at your first prenatal visit. It will also be tested again late in the second trimester or early in the third trimester.
Your practitioner will look at the following:
  • Hematocrit level—the percentage of red blood cells in your blood compared to total blood volume
  • Hemoglobin level—the amount of hemoglobin in your blood

Treatment

The treatment for anemia in pregnancy depends on the cause of the anemia. Dietary changes usually are not enough. Treatment options include:

Iron Supplementation

Your doctor may prescribe an iron supplement of 60 mg-120 mg of iron per day. For best results, take iron supplements on an empty stomach. Foods that are high in vitamin C, like oranges and other citrus fruits, will help your body absorb iron. Coffee, tea, milk, and calcium supplements can block absorption of iron. Avoid consuming these at the same time as your iron supplement.
Iron supplements may cause constipation and/or nausea. If your iron supplement causes constipation, then try increasing your fluid and fiber intake. If your iron supplement causes an upset stomach, your practitioner may advise that you take it with food or may prescribe a different formula.

Folic Acid or Vitamin B12 Supplementation

If a folic acid or vitamin B12 deficiency is causing your anemia, your practitioner may prescribe a vitamin supplement.

Prevention

Do the following to help reduce your chances of developing anemia in pregnancy:
  • Seek early prenatal care.
  • Take a prenatal vitamin containing 30 mg of iron, as prescribed by your practitioner, from the beginning of pregnancy.
  • Eat foods that are high in iron including red meat, poultry, pork, shellfish, beans, iron-fortified breads and cereals, dried fruits, and leafy green vegetables.
  • Eat foods that contain folic acid including whole grains, wheat germ, broccoli, beans, orange juice, and leafy green vegetables.

RESOURCES

The American Congress of Obstetricians and Gynecologists http://www.acog.org/For%5FPatients

American Pregnancy Association http://www.americanpregnancy.org/

National Women’s Health Information Center http://www.womenshealth.gov/

CANADIAN RESOURCES

Health Canada http://www.hc-sc.gc.ca

The Society of Obstetricians and Gynaecologists of Canada http://www.sogc.org

References

American Dietetic Association. Nutrition and Lifestyle for a Healthy Pregnancy Outcome. J Am Diet Assoc . 2002; 102:1470-1490.

Anemia & pregnancy. American Society of Hematology website. Available at: http://www.hematology.org/patients/blood-disorders/anemia/5227.aspx . Accessed December 18, 2012.

Anemia in pregnancy. The American Congress of Obstetricians and Gynecologists, Practice Bulletin No 95 . July 2008 (Reaffirmed 2010).

Beers MH, Berkow R, Burs M, eds. The Merck Manual of Diagnosis and Therapy . Whitehouse Station, New Jersey: Merck Research Laboratories; 1999.

Gordon D. Obstetrics, Gynecology, and Infertility. 5th ed. Arlington, VA: Scrub Hill Press; 2001.

Hemoglobinopathies in Pregnancy, American College of Obstetricians and Gynecologists, Practice Bulletin, no. 78, January 2007.

Revision Information

  • Reviewer: Andrea Chisholm
  • Review Date: 11/2012 -
  • Update Date: 03/28/2013 -

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

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