Anemia in pregnancy

Iron deficiency anemia, or iron deficiency anemia, is a blood disease due to a reduced amount of iron which is an essential element of the hemoglobin present in red blood cells.

Hemoglobin is the molecule responsible for transporting oxygen to all parts of our body.

We need an adequate supply of iron in order to make enough healthy red blood cells and to keep hemoglobin at the right level. If this is not done, anemia may develop.

Anemia is a very common disorder, especially in women of childbearing age. Iron deficiency is by far the most common cause of anemia in pregnancy, accounting for 75 to 95% of all anemia cases.

However, the lack of iron is not the only possible cause of anemia in pregnancy: in fact, anemia can also develop,

  • for a lack of folic acid or vitamin B12,
  • due to a hemorrhage,
  • or due to certain hereditary blood disorders or diseases, such as sickle cell anemia or thalassemia.

Causes of anemia in pregnancy

Pregnancy increases a woman’s chances of becoming anemic. During pregnancy, the recommended amount of iron to take increases from 18 milligrams (mg) to 27 mg per day.

There is therefore the need to take “extra iron” in order to be able to support an adequate production of red blood cells, the maintenance of the placenta which is the organ responsible for metabolic exchanges between the developing fetus and the mother.

But it also serves to prepare the future mother’s body to cope with any blood loss that may occur during childbirth.

However, in addition to pregnancy itself, there are also other causes that can increase the risk of anemia in women. Among these we mention,

  • particularly heavy menstruation,
  • diets low in iron-rich foods,
  • diets with foods low in vitamin C (foods that help the absorption of iron),
  • eating too many foods or drinks that reduce iron absorption (such as dairy products, foods containing soy, coffee and tea),
  • having two very close pregnancies,
  • being under 20 when you become pregnant,
  • having a bowel disease that affects the way your body absorbs nutrients,
  • having undergone certain types of surgery such as gastric bypass, which alter the intestine and the absorption of nutrients,
  • taking any medications that affect the way the body absorbs iron from food,
  • the hemorrhages.

Symptoms of anemia in pregnancy

in the case of mild anemia

When the anemia is mild, a woman is likely to experience no symptoms during pregnancy. Sometimes the only sign is tiredness.

However, for a pregnant woman, feeling tired is a normal thing, and therefore many women do not realize that it is the lack of iron that makes them feel more tired than normal.

in the case of severe anemia

Again tiredness and weakness are the most common symptoms of severe anemia, while the other possible symptoms include,

  • feeling breathless,
  • dizziness,
  • the headache ,
  • a pale complexion,
  • the palpitations,
  • a pain in the chest,
  • irritability or problems concentrating,
  • an unpleasant urge to move the legs during periods of inactivity (restless legs syndrome),
  • leg cramps,
  • the desire for non-food items, or ice to suck or chew,
  • pallors of: lips, inner eyelids, inside of the mouth,
  • spoon-shaped nails,
  • clear tongue,
  • cuts in the corners of the mouth.

Diagnosis of anemia in pregnancy

How is anemia in pregnancy diagnosed?

At the first prenatal visit, the doctor will evaluate the woman’s medical history, examine her, and order blood tests to detect possible anemia.

One of the tests he will order is a complete blood count. Among other things, this test measures,

  • the percentage of red blood cells in the blood (hematocrit or Hct);
  • the amount of hemoglobin (Hgb or Hb) in red blood cells.

The values ​​of anemia in pregnancy

The ACOG (American College of Obstetricians and Gynecologists) and the CDC (US – Centers for Disease Control) provide us with some guidelines for diagnosing anemia:

  • In the first and third trimester , a Hct (hematocrit) lower than 33% and a Hgb (hemoglobin) level lower than 11 grams (g) of hemoglobin per deciliter (dL) of blood, are values ​​that suggest the existence of a state of anemia.
  • In the second trimester , the recommended values ​​are slightly lower: 32% Hct and 10.5 Hgb g/dL.

The doctor may decide to follow the trend of the values ​​emerged from the blood tests over time, prescribing multiple tests in order to be able to establish whether the cause of the anemia is really an iron deficiency.

Even if the mother-to-be has never been anemic, as the pregnancy progresses, it is possible that she will develop anemia. For this reason it is important to do tests later in the months.

Consequences on pregnancy?

When faced with a diagnosis of anemia, it is normal for a woman to be concerned.

l’anemia mild

If it is mild and if it is diagnosed and treated early, iron deficiency anemia is not a problem for pregnancy. It is possible that the pregnant woman gets tired or fatigued more easily when her iron values ​​are low. If your doctor tells you to take iron supplements, and if you take them as directed, your values ​​should improve.

l’anemia grave

Most experts agree that anemia in pregnancy is more of a concern,

  • when it’s serious
  • when it is not treated,
  • or when it continues over time.

If you have severe anemia, you will probably be treated by an injection of iron supplements into a vein or – in some cases if the hemoglobin drops below 6 g/dL – directly by a blood transfusion.

very severe anemia

If the pregnant woman has very severe anemia that does not respond to treatment, the doctor can consult a specialist to identify the best strategy.

You may need to see a hematologist or maternal-fetal medicine specialist to determine if there are any contributing factors that are causing the anemia.

in any case

A pregnancy can be exhausting especially when you are penalized by having a low amount of iron in the blood: so it is always good to slow down and take care of yourself.

Consequences on the child

A mild iron deficiency during pregnancy should not affect the health of the unborn baby. However, research indicates that mild iron deficiency anemia in pregnancy – when untreated and especially in the first two trimesters – is linked to an increased risk of the baby being born low.

Severe anemia due to iron deficiency can also increase the risk of neonatal death.

What to do in these cases

Here are the things to do in case of iron deficiency anemia.

Inform your doctor if you were diagnosed with iron deficiency anemia before becoming pregnant, so that they can better manage the disorder and treat you effectively during pregnancy.

As in any pregnancy it is important,

  • that pregnant women regularly make all the prescribed medical examinations,
  • taking prescribed prenatal vitamins,
  • that they follow the advice of the doctor, who could also suggest taking other iron supplements or changing their eating habits.

Those foods that contain vitamin C such as orange juice, strawberries, broccoli, grapefruit and peppers improve iron absorption. If you eat foods rich in iron, such as shrimp, beef, turkey, grains, beans and lentils, anemia may improve. Instead, it is advisable to avoid taking too many foods or drinks that hinder the absorption of iron, such as dairy products, soy-based products, coffee and tea. If you were to consume these foods / drinks, it would be better to take them or a hour before or two hours after iron intake.

Finally, when taking an iron supplement, it is good practice to accompany it with a small snack. Conversely, eating large amounts of food hinders iron absorption.

Katherine Johnson, M.D., is a board-certified obstetrician-gynecologist with clinical expertise in general obstetrics and gynecology, family planning, women’s health, and gynecology.

She is affiliated with the Obstetrics and Gynecology division at an undisclosed healthcare institution and the online platform,

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