During pregnancy, your body’s demand for iron increases significantly.
It’s an essential mineral needed to make hemoglobin (Hb) – the protein in red blood cells that carries oxygen around the body.
Your growing baby also needs iron, and stores it for the first six months of life outside the womb.
For these reasons, it’s really important to try to prevent anemia during pregnancy.
In this article, we’ll cover everything you need to know about anemia during pregnancy – from the signs and symptoms of anemia, to its causes and treatment.
Why is iron so important?
Iron is primarily absorbed through the intestine.
Once iron is absorbed, a protein called transferrin transports it through the blood to the liver, spleen and bone marrow, to make red blood cells.
Hemoglobin (Hb) is the protein in the red blood cell that gives blood its red color. Oxygen, which is necessary for all cells to live and carry out their functions, attaches itself to hemoglobin.
If the bone marrow doesn’t make enough healthy red blood cells, there won’t be enough Hb to carry oxygen around the body.
Ferritin is usually stored in large amounts in the brain and liver. We often hear ferritin referred to as ‘stored iron’ as it’s the back up supply your body relies on if for some reason, there isn’t enough circulating in your system.
What is iron deficiency anemia?
Anemia occurs when the body doesn’t have enough healthy red blood cells to transport oxygen to all organs and tissues.
There are a number of different types of anemia, including:
- Iron deficiency anemia – caused by a lack of iron needed to produce enough hemoglobin to carry oxygen around the body
- Vitamin deficiency anemia – caused by a lack of certain vitamins. It might be folate deficiency anemia (which is sometimes known as vitamin B9 deficiency), vitamin B12 deficiency anemia, or vitamin C deficiency anemia. Vitamin deficiency anemia only occurs when there aren’t enough vitamins consumed in the diet, or if they can’t be absorbed due to certain medical conditions or medications. Being deficient in these vitamins prevents the body from producing enough healthy red blood cells
- Sickle cell and thalassemia – both are inherited blood disorders. People with sickle cell have red blood cells shaped like a sickle or crescent moon instead of being round. The sickle shape travels less easily around the body and can become stuck in smaller blood vessels. This interferes with blood flow and cells can be damaged or die. Thalassemia occurs when not enough hemoglobin is produced, meaning not enough oxygen can be carried. Treatment for both may require blood transfusion
- Aplastic anemia – a form of autoimmune disorder. It occurs when the stems cells in the bone marrow don’t produce enough blood cells, leading to a low red blood cell count.
Anemia during pregnancy
The most common form of anemia during pregnancy is iron deficiency anemia; it ranges from mild to severe. The condition is usually easy to correct through nutrition or supplementation.
The most common cause of anemia in pregnancy is low iron. Your body needs twice the amount of iron during pregnancy, to provide enough oxygen to you body and your growing baby.
Pregnancy anemia occurs when the amount of iron consumed and absorbed doesn’t match the body’s demand.
Symptoms of anemia in pregnancy
Iron deficiency anemia in pregnancy is also referred to as pregnancy anemia.
Women might experience any of the following common symptoms of anemia during pregnancy:
- Paleness of the skin
- Fatigue and feeling weak
- Shortness of breath
- Racing heart or palpitations
- Difficulty concentrating
- Cravings for non-food substances (pica).
Some of these symptoms seem to go hand in hand with pregnancy and growing a baby. But they often indicate that your Hb levels are too low, and you’re actually anemic.
Normal low iron during pregnancy
During pregnancy your body increases its blood volume, to provide extra blood flow through the placenta to support your baby. During the second half of pregnancy your blood volume increases by up to 50%.
During this time it’s normal for your Hb levels to go down, as the red blood cells can’t increase fast enough to keep up with the higher volume of blood.
Women who have enough stored iron (ferritin), shouldn’t really notice any physical effects of this slightly lowered Hb.
However, if you don’t have enough red blood cells and stored iron to meet the increased demand pregnancy makes on your body and your growing baby, this is when you’re at risk of developing iron deficiency anemia.
Who is most at risk of developing pregnancy anemia?
Pregnancy itself increases your chances of becoming anemic. Certain women, however, are even more likely to develop anemia during pregnancy.
Any of the following reasons could affect your body’s iron levels, or its ability to absorb iron from food:
- Previous anemia or if you’re currently taking iron tablets
- Previous use of the contraceptive pill
- Previous heavy periods
- Pregnancies spaced closely together
- Twin pregnancy
- Severe morning sickness
- Gastric problems – weight loss surgery, Crohn’s disease or celiac disease
- Poor diet
- Significant blood loss following birth.
How do you know if you’re anemic in pregnancy?
Your healthcare provider will screen your iron levels to watch out for anemia in pregnancy.
A blood test is usually done at the start of pregnancy, and again as you enter your third trimester, usually around 28 weeks pregnant. This is when the body’s demand for iron increases significantly.
If you’re found to be anemic, your levels may be tested again before you give birth.
Anemia is diagnosed with a blood test that looks at various components (hematocrit levels, Hb and ferritin), as well as the size and color of your red blood cells.
For more information please read Blood Test For Pregnancy | What You Need To Know.
What is a normal hemoglobin level for a pregnant woman?
The World Health Organization (WHO) defines anemia in pregnancy as a hemoglobin concentration less than 11g/dl in the first trimester and 10.5g/dl in the third.
However the level that’s deemed ‘normal’ has been hotly debated amongst experts in the field, as BellyBelly midwife Irene Garzón explains:
‘Although real anemia must be promptly and efficiently treated, during pregnancy women develop physiological anemia to ease the blood flow through the placenta. According to Dr Odent, ‘a Hb of 8.5 to 9.5 during the second half of pregnancy is associated with the best possible birth outcomes’. However, most health care providers will try to supplement women whose Hb falls under 10g/dl at 28 weeks, ignoring how perfectly prepared our bodies are’.
If you experience symptoms of anemia during pregnancy, speak to your doctor for more advice before starting any new supplement regime.
How does anemia affect baby during pregnancy?
If left untreated, severe iron deficiency anemia during pregnancy can increase your risk of serious complications.
- Poor fetal growth
- Preterm delivery
- Low birth weight baby
- Higher risk of birth defects, stillbirth or newborn death.
Iron deficiency in pregnancy is also one of the leading causes of anemia in infants and young children, so it’s really important to try to prevent it if possible.
Being anemic in pregnancy can leave you feeling pretty weak and fatigued. It also increases the risk of blood loss during birth and makes it more difficult to fight infection, as it compromises your immune system.
Interestingly, new research indicates iron deficiency anemia in pregnancy can also put women at a greater risk of postpartum depression.
Can I prevent anemia in pregnancy?
The best way to prevent anemia in pregnancy is to ensure you’re covering all your nutritional bases.
If you’re planning to become pregnant, focus on your pre-pregnancy nutrition to optimize your iron levels before you conceive. This helps ensure your body is in the best possible shape, nutritionally speaking.
It’s recommended pregnant women have 27 mg of iron per day.
Once you’re pregnant, be sure to include iron rich foods throughout your pregnancy, as part of your daily diet.
Keep reading for tips on how to make that happen.
What should a pregnant woman with anemia eat?
Most women hear ‘iron rich food’ and automatically think this means having to eat red meat at every meal.
Although animal products are a good source of dietary iron (called heme iron), there are many ways to include in your diet iron rich foods that aren’t animal-based.
Non-heme iron mainly comes from plant sources. These include eggs, spinach, kidney beans, lentils, dried apricots, blackstrap molasses, almonds and fortified cereals.
However, less than 5% of iron from non-heme sources is absorbed. Eating vitamin C rich foods with non-heme sources can improve iron absorption.
If you need a little inspiration for what to include in your diet, read our article 7 Iron Rich Foods For Pregnancy.
How can I raise my iron levels quickly?
Some foods can reduce your body’s ability to absorb iron.
To help your body absorb iron more efficiently, avoid eating or drinking these things at the same time as your iron rich foods:
- Coffee, tea and wine. They contain tannins, which bind to iron and carry it out of the body
- Wholegrains, such as whole wheat bread. They contain phytates and fiber, which also reduce absorption
- Calcium and calcium supplements reduce iron absorption. Avoid taking your supplements with milk or dairy products.
If you’re taking iron supplements, have them with a glass of orange juice or tomato juice. It’s well known that vitamin C helps your body’s absorption of iron.
Women with a normal blood count don’t receive any health benefits from taking 30 mg of iron daily, although the risks of anemia are lowered. Most prenatal vitamins contain iron as part of the overall nutritional intake.
How is anemia treated in pregnancy?
The treatment for anemia will differ, depending on the type of anemia you have.
Treatment during pregnancy, however, is usually pretty straightforward.
In simple terms: your body needs more iron. Upping your iron intake will help correct the problem.
If your healthcare provider diagnoses you with anemia, the first thing to focus on is your diet.
Increasing your dietary intake of iron will help raise your levels, but sometimes this isn’t enough to bring them up sufficiently.
If your diet is already pretty good, and you’re already consuming iron rich foods, the next step would be to take an iron supplement.
Supplementation, along with a healthy varied diet, should be enough to bump up your levels before you give birth.
It’s important to consult with your doctor or midwife before taking any new supplement or medicine in pregnancy. Determining the cause of your anemia will guide your treatment options.
Should I take an iron supplement in pregnancy?
When your body is already low in iron and anemic, it can be difficult to get enough iron, even if your dietary intake is high.
Most care providers will prescribe oral iron supplements for mild to moderate anemia.
It’s important to note oral iron supplements aren’t a ‘one size fits all’ treatment, and some forms can cause constipation and digestive upsets.
Higher doses of iron can also cause nausea and vomiting. Liquid forms are usually tolerated much better, but practitioner-only brands (from naturopaths) are often much gentler on the stomach.
For some women, supplements work quickly and their symptoms will start to improve within a few weeks. Others might not notice any difference and might need to change supplements to find one that works best for them.
When supplementation isn’t enough
Severe anemia during pregnancy might require iron supplementation via injection or infusion (IV drip). This is usually reserved as a last resort for severe anemia or if you’re very close to giving birth and there isn’t time for oral supplementation to increase your iron levels.
When to talk to your doctor?
If you have symptoms of iron deficiency anemia, speak to your doctor or midwife. They can order a full blood panel test to assess your levels.
This provides a full overview of your nutritional status and will help determine the cause, the best form of treatment if needed, and the best way to manage your symptoms.