Anemia in Pregnancy

What is anemia?

Anemia is when your blood has too few red blood cells. Having too few red blood cells makes it harder for your blood to carry oxygen or iron. This can affect how cells work in nerves and muscles. During pregnancy, your baby also needs to get nutrients and oxygen from your blood.

Who is at risk for anemia during pregnancy?

Women are more likely to get anemia during pregnancy if they:

• Are strict vegetarians or vegans. They are at greater risk of having a vitamin B12 deficiency. 

• Have celiac disease or Crohn's disease, or have had weight loss surgery where the stomach or part of the stomach has been removed

Women are more likely to get iron-deficiency anemia in pregnancy if they:

• Have two pregnancies close together

• Are pregnant with twins or more

• Have vomiting often because of morning sickness

• Are not getting enough iron from their diet and prenatal vitamins

• Had heavy periods before pregnancy

What causes anemia during pregnancy?

You can get several kinds of anemia during pregnancy. The cause varies based on the type.

• Anemia of pregnancy. During pregnancy, the volume of blood increases. This means more iron and vitamins are needed to make more red blood cells. If you don't have enough iron, it can cause anemia. It's not considered abnormal unless your red blood cell count falls too low.

• Iron-deficiency anemia. During pregnancy, your baby uses your red blood cells for growth and development, especially in the last 3 months of pregnancy. If you have extra red blood cells stored in your bone marrow before you get pregnant, your body can use those stores during pregnancy. Women who don't have enough iron stores can get iron-deficiency anemia. This is the most common type of anemia in pregnancy. Good nutrition before getting pregnant is important to help build up these stores.

• Vitamin B-12 deficiency. Vitamin B-12 is important in making red blood cells and protein. Eating food that comes from animals, such as milk, eggs, meats, and poultry, can prevent vitamin B-12 deficiency. Women who don't eat any foods that come from animals (vegans) are most likely to get vitamin B-12 deficiency. Strict vegans often need to get vitamin B-12 shots during pregnancy.

• Folate deficiency. Folate (folic acid) is a B vitamin that works with iron to help with cell growth. If you don't get enough folate during pregnancy, you could get iron deficiency. Folic acid helps cut the risk of having a baby with certain birth defects of the brain and spinal cord if it's taken before getting pregnant and in early pregnancy.

What are the symptoms of anemia during pregnancy?

You may not have clear symptoms of anemia during pregnancy unless your cell counts are very low. Symptoms may include:

• Pale skin, lips, nails, palms of hands, or underside of the eyelids

• Feeling tired

• Sensation of spinning (vertigo) or dizziness

• Labored breathing

• Rapid heartbeat (tachycardia)

• Trouble concentrating

The symptoms of anemia can be like other health conditions. Always see your healthcare provider for a diagnosis.

How is anemia during pregnancy diagnosed?

Your healthcare provider will check for anemia during your prenatal exams. It's usually found during a routine blood test. Other ways to check for anemia may include other blood tests, such as: 

• Hemoglobin. This is the part of blood that carries oxygen from the lungs to tissues in the body.

• Hematocrit. This measures the portion of red blood cells found in a certain amount of blood.

How is anemia during pregnancy treated?

Treatment will depend on your symptoms, age, and general health. It will also depend on how bad the condition is.

Treatment for iron deficiency anemia includes taking iron supplements. Some forms are time-released. Others must be taken several times each day. Taking iron with a citrus juice, such as orange, can help your body absorb it better. Taking antacids may make it harder for your body absorb to iron. Iron supplements may cause nausea and cause stools to become dark greenish or black in color. They may also cause constipation.

What are possible complications of anemia during pregnancy?

If you have anemia during pregnancy, your baby may not grow to a healthy weight, may arrive early (preterm birth), or have a low birth weight. Also being very tired may keep you from recovering as quickly after birth.

Can anemia during pregnancy be prevented?

Good nutrition before pregnancy not only helps prevent anemia, but it also helps build other nutritional stores in your body. Eating a healthy, balanced diet before and during pregnancy helps keep up your levels of iron and other important nutrients needed for your growing baby.

Good food sources of iron include:

• Meats. Beef, pork, lamb, liver, and other organ meats.

• Poultry. Chicken, duck, turkey, and liver, especially dark meat.

• Fish. Shellfish, including (fully cooked) clams, mussels, and oysters are good. So are sardines and anchovies. The FDA recommends that pregnant women eat 8 to 12 ounces per week of fish that are lower in mercury. These include salmon, shrimp, pollock, cod, tilapia, tuna (light canned), and catfish. Don't eat fish with high levels of mercury, such as tilefish from the Gulf of Mexico, shark, swordfish, and king mackerel. Limit white (albacore) tuna to only 6 ounces per week.

• Leafy greens of the cabbage family. These include broccoli, kale, turnip greens, and collards.

• Legumes. Lima beans and green peas; dry beans and peas, such as pinto beans, black-eyed peas, and canned baked beans.

• Yeast-leavened whole-wheat bread and rolls

• Iron-enriched white bread, pasta, rice, and cereals

Experts recommend all women of childbearing age and all women who are pregnant take vitamin supplements with at least 400 micrograms of folic acid. Folate is the form of folic acid found in food. Good sources are:

• Leafy, dark green vegetables

• Dried beans and peas

• Citrus fruits and juices and most berries

• Fortified breakfast cereals

• Enriched grain products

Key points about anemia in pregnancy

• Anemia is a condition of too few red blood cells.

• Four kinds of anemia can happen during pregnancy: anemia of pregnancy, iron deficiency anemia, vitamin B-12 deficiency, and folate deficiency.

• Anemia may cause your baby to not grow to a healthy weight. Your baby may also arrive early (preterm birth) or have a low birth weight.

• Anemia is usually found during a routine blood test for hemoglobin or hematocrit levels.

• Treatment depends on the type of anemia and how bad it is.

• Good nutrition is the best way to prevent anemia during pregnancy.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

• Know the reason for your visit and what you want to happen.

• Before your visit, write down questions you want answered.

• Bring someone with you to help you ask questions and remember what your provider tells you.

• At the visit, write down the name of a new diagnosis and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.

• Know why a new medicine or treatment is prescribed and how it will help you. Also know what the side effects are.

• Ask if your condition can be treated in other ways.

• Know why a test or procedure is recommended and what the results could mean.

• Know what to expect if you do not take the medicine or have the test or procedure.

• If you have a follow-up appointment, write down the date, time, and purpose for that visit.

• Know how you can contact your healthcare provider if you have questions, especially after office hours or on weekends.