Low red blood cells in pregnancy (anaemia)

When you are pregnant, you are at risk of anemia.
If you’re anemic, it means you don’t have enough healthy red blood cells to carry oxygen to your tissues and to your baby.

Anemia in pregnancy

During pregnancy, a woman’s body produces more blood to support the growth of the baby.

However, if you do not get enough iron or other specific nutrients, your body may not be able to produce enough red blood cells to produce the necessary (extra) blood.

It is normal to have a slight anemia during pregnancy. But it could also be something more serious: either due to iron deficiencies, vitamins, or other causes.

Anemia makes a woman more tired and weaker. When an important anemic form is not adequately treated, it can increase the risk of serious complications, of a pre-term birth for example.

Here we aim to cover what you need to know about the causes of low red blood cells, their symptoms, and treatments for anemia in pregnancy.

Types of anemia and their risks

The term anemia refers, not to just one but to several conditions of hemoglobin deficiency circulating in the blood within the red blood cells (erythrocytes).

Although they have several characteristics in common, these are conditions that can depend on very different causes. Even during a pregnancy, different types of anemia can therefore occur, including:

an iron deficiency anemia

This type of anemia occurs when a woman’s body does not have enough iron to make enough hemoglobin.

Hemoglobin is a protein found in red blood cells that carries oxygen from the lungs to the rest of the body. The most common cause of anemia in pregnancy is iron deficiency.

In iron deficiency anemia, the blood cannot carry enough oxygen through the body to the tissues. Severe or untreated iron deficiency can increase your risks:

  • of a pre-term birth,
  • of a low birth weight baby;
  • that a blood transfusion is required in the event of significant blood loss during childbirth;
  • of  postpartum depression
  • of an anemic child;
  • of a child with developmental problems.

folic acid deficiency anemia

  • Folic acid (also called vitamin B9) is a vitamin naturally present in some foods such as green leafy vegetables.
  • It is a vitamin that our body needs to produce new cells, including red blood cells – not just during pregnancy.
  • Expectant women have a greater need for folic acid, however in some cases they are unable to get enough through their normal diet.
  • When this happens, their body cannot make enough ‘normal’ red blood cells to carry oxygen to the tissues.

A folic acid/vitamin B9 deficiency can directly contribute to some birth defects , such as a malformation of the neural tube (spina bifida), and low birth weight.

Severe or untreated folic acid deficiency anemia can increase a woman’s risk of:

  • a preterm birth or a low birth weight baby,
  • the need for a blood transfusion if you lose a significant amount of blood during childbirth;
  • a postpartum depression;
  • an anemic child;
  • a child with developmental delays;
  • a child with serious birth defects involving the spinal cord or brain (neural tube defects).

To counteract it, it is possible to use folic acid food supplements.

a vitamin B12 deficiency anemia

  • To produce healthy red blood cells, our bodies also need vitamin B12.
  • If a pregnant woman does not get enough vitamin B12 from her normal diet, her body cannot produce the necessary red blood cells.
  • Women who do not consume meat, poultry, dairy products and eggs in their diets have an increased risk of
  • a vitamin B12 deficiency, a condition which – as already mentioned – if left untreated could contribute to causing birth defects in the baby, such as neural tube malformations, but also cause a preterm birth.

blood loss anemia

  • Excessive blood loss can also cause anemia.

The risk factors of an anemia

All pregnant women, some more, some less, are at risk of having low red blood cells and therefore being anemic. And this is because in their condition they need more iron and more folic acid/vitamin B9 than normal. This risk is greater, however,

  • in the case of a multiple pregnancy (more than one child),
  • if you have had two pregnancies close to each other,
  • if you vomit a lot due to morning sickness,
  • if they are still teenagers,
  • if they do not eat enough foods rich in iron,
  • six were already anemic before becoming pregnant.

Symptoms of anemia in pregnancy

The most common symptoms due to anemia during pregnancy are,

  • a widespread paleness of the skin, lips and nails,
  • a feeling of tiredness or weakness,
  • dizziness,
  • shortness of breath,
  • tachycardia,
  • concentration problems.

In the early stages of anemia, a woman may not have obvious symptoms. Furthermore, many of the symptoms related to anemia are the same as they might have even with a normal pregnancy in the absence of anemia.

Therefore it is appropriate that during their prenatal visits those blood tests (routine) that show the presence or absence of anemia are done.

Tests for anemia in pregnancy

During the first prenatal visit, blood tests are also done to check whether or not the woman is anemic:

  • The hemoglobin test,  which measures how much hemoglobin – an iron-rich protein found in red blood cells that carries oxygen from the lungs to body tissues – is present.
  • The hematocrit test , which measures the percentage of red blood cells in a blood sample.

If you have lower than normal hemoglobin or hematocrit levels, you could have iron deficiency anaemia. If so, your doctor may order further blood tests to better determine whether it is due to deficiencies or other causes.

Even if the woman is not anemic in early pregnancy, later in the second or third trimester, the doctor will probably advise her to have additional blood tests to check for possible anemia.

Treatments for anemia

If the pregnant woman is anemic,

  • you may need to take an iron and/or folic acid supplement in addition to your prenatal vitamins;
  • your doctor may suggest that you add foods richer in iron and folic acid to your usual diet.

After a certain period of time you will certainly be ordered to have another blood test so that we can check if your hemoglobin and hematocrit levels are improving.

To treat a vitamin B12 deficiency, your doctor may recommend you take a vitamin B12 supplement and introduce more foods of animal origin such as meat, eggs, dairy products into your diet.

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, Maternicity.com.

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