Most people think of pregnancy as a time when women are glowing with good health. That healthy glow is actually due to the extra blood a pregnant woman has in her body to support herself and her growing fetus. The amount of blood in the body increases 20 to 30 percent when a woman is pregnant. Some women experience anemia during pregnancy, however. In some cases this is nothing to worry about, but in others, treatment may be needed to keep the anemia at bay.
What is Anemia?
Anemia is a very common condition, especially in women. Anemia in pregnancy is typically caused by a lack of red blood cells or a low level of hemoglobin (a protein found in red blood cells). Pregnancy requires more iron, especially during the second and third trimesters, and when there isn’t enough available, anemia can be the result.
The causes of anemia are varied, but some forms are more common in pregnant women, such as iron deficiency anemia and vitamin deficiency anemia.
Iron deficiency anemia: The body needs iron in order to make red blood cells. This form of anemia is due to a lack of iron in the diet, poor absorption of iron, or loss of iron due to bleeding. It is the most common form of anemia in pregnant women.
Vitamin deficiency anemia: Most vitamins and minerals have “helpers” — vitamins, minerals, fats, or proteins that help other vitamins to be used properly by the body. In the case of iron, folic acid and vitamin B12 are the helpers needed to make red blood cells. When there is a lack of folic acid or vitamin B12, the body may not make enough red blood cells. Vitamin D deficiency is another common cause of anemia.
These other types of anemia are not as common in pregnant women:
Anemia caused by chronic disease: This type of anemia occurs when disease is inhibiting blood cell production.
Hemolytic anemia: With this condition, red blood cells are broken down and absorbed faster than they can be created, which results in anemia.
Aplastic anemia: In this rare condition, there is a lack of red blood cells because the bone marrow stops producing them.
What Can Cause Anemia during Pregnancy?
Pregnant women need more iron, folic acid, vitamin D, and vitamin B12 to produce the higher volume of blood they need during pregnancy. A diet that is insufficient in any of these can result in anemia. Getting enough folic acid before and during pregnancy is important; fortunately, many foods are now fortified with folic acid. Besides anemia, a folic acid deficiency in the mother can also to lead to neural tube birth defects such as spina bifida.
Who is at Risk for Anemia During Pregnancy?
Every pregnant woman is at risk of developing anemia. Women who eat a vegetarian or a vegan diet are also at risk for vitamin B12 deficiency, which can lead to anemia. Blood is also lost during labor and delivery, which can also lead to anemia.
Women who are at a higher risk for developing anemia during pregnancy are those who:
- Are carrying more than one baby
- Are in their teens
- Tend to have a heavy menstrual flow
- Have closely spaced pregnancies
- Have experienced significant vomiting
- Have a lack of dietary iron
What are the Symptoms of Anemia?
A classic sign of anemia is fatigue. In pregnant women, fatigue may set in early in the pregnancy and continue throughout (and thereafter), making feeling tired an unreliable indicator of a low red blood cell count. Many women blame the symptoms of anemia on their pregnancy itself, which may make a low red blood-cell count difficult to catch. Other signs of anemia include:
- Difficulty concentrating
- Weakness or dizziness
- Irregular/rapid heartbeat
- Shortness of breath
How can Anemia be Prevented?
In many cases, anemia is preventable by eating a varied diet that provides the vitamins and minerals the body needs to produce a healthy number of red blood cells (see lists 1 and 2 below). A diet with enough iron, vitamin C, vitamin D, folic acid, and vitamin B12 can often prevent anemia. Vitamin B12 can be a special issue for women who don’t eat meat products, and supplementation may be necessary in some cases. Talk to your doctor if you are concerned about anemia, or about whether you are getting enough vitamins and minerals from your diet.
Complications of Anemia During Pregnancy
Mild anemia is fairly common in women — especially pregnant women — but severe anemia that goes untreated can have significant consequences for the growing fetus and the mother. Some of the potential complications include early labor and birth, low birth weight, and postpartum depression.
Preterm birth: It’s unclear why, but women who are anemic in their first trimester are more likely to go into early labor.
Low birth weight: Anemia during pregnancy is a risk factor for having a baby with a low birth weight (less than 5.5 lbs).
Postpartum depression: Women who are anemic during their third trimester are more likely to develop postpartum depression.
Some more uncommon complications of anemia in pregnancy are:
Need for a blood transfusion: Severe anemia — i.e., anemia that requires rapid resolution before delivery — can sometimes be treated with a blood transfusion. Transfusions carry their own risks, and are not commonly performed on pregnant women.
Neural tube defects: While not a direct result of anemia, neural tube defects are associated with a lack of dietary folic acid. A deficiency in folic acid can lead to anemia, and in severe cases, to birth defects such as spina bifida.
How is Anemia Diagnosed during Pregnancy?
Pregnant women are routinely tested for anemia. This is most often done with a simple blood test, usually at an initial prenatal doctor’s appointment. The test will be repeated during the second and third trimesters as necessary. Blood is most often taken from the arm by a qualified health professional in a doctor’s office or a clinic. Two blood tests that are often performed to diagnose anemia are a hemoglobin test and a hematocrit test.
Hemoglobin level test: Blood is tested for the level of hemoglobin, a blood protein that is needed to carry oxygen to the body’s cells. A low level of hemoglobin indicates a form of anemia could be present. The normal range for hemoglobin in pregnant women is 11 to 12 g/dl.
Hematocrit level test: This test measures the percentage of red blood cells in the blood. A hematocrit level lower than the normal range indicates a low level of red blood cells and could indicate anemia. The normal range for hematocrit in pregnant women is from 32 to 28.
How is Anemia in Pregnancy Treated?
Mild anemia during pregnancy is typically treated with iron and folic acid supplements. Most women are advised to take prenatal vitamins before and during their pregnancy; these vitamins contain both iron and folic acid, as well as many other vitamins and minerals. Women with more severe or persistent anemia may be advised to take additional supplements of iron, folic acid, vitamin D, or vitamin B12. Which supplements, and how much, will be determined by a healthcare professional.
Pregnant women may also be counseled about their nutrition, if necessary. Getting vitamins and minerals through diet is going to be the best way to meet the needs of the growing baby. Some women may not know which foods to eat in order to meet their new dietary requirements, and a qualified healthcare professional can help develop an optimal eating plan.
Common Food Sources Of Iron For Pregnant Women
- Red Meat (beef and pork)
- Chicken (especially chicken liver)
- Turkey
- Fish such as cod, flounder, salmon halibut, haddock, perch, or canned light tuna (up to 12 ounces a week)
- Leafy, green vegetables (spinach, broccoli, kale)
- Fortified breakfast cereals and oatmeal
- Lima beans, red kidney beans, chickpeas, or pinto beans
- Pumpkin, sesame, or squash seeds
- Blackstrap molasses
- Tofu
- Enriched egg noodles
- Eggs
- Wheat germ
Common Food Sources of Folic Acid for Pregnant Women
- Lentils
- Dark green vegetables (broccoli, spinach, collard greens, turnip greens, okra, and asparagus)
- Citrus fruits and juices
- Fortified breakfast cereals, pasta, grains, and rice
- Dried beans