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Definition

Anemia is a low level of healthy red blood cells (RBC). RBCs carry oxygen from the lungs to the rest of the body. The body does not get enough oxygen when RBCs are low in number.

Blood is made up of many blood cell types and plasma. These all increase during pregnancy. RBCs do not go up as much, which can lead to anemia.

Red Blood Cells
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Causes

The most common cause is low iron levels. Iron is a mineral found in hemoglobin. Hemoglobin is the part of the RBC that carries oxygen. The body needs more iron during pregnancy. Anemia happens when these needs are not met.

Other causes are:

  • Low amounts of folic acid or vitamin B12
  • Loss of blood because of injury, a bleeding ulcer, or bleeding hemorrhoids
  • Problems in the genes causing less hemoglobin to be made or hemoglobin that does not work as it should

Risk Factors

The risk of anemia in pregnancy is higher for:

  • Having anemia before pregnancy
  • Very heavy bleeding during periods before pregnancy
  • Morning sickness with frequent vomiting
  • Pregnancies that are close together
  • Having more than one baby
  • Eating foods low in iron
  • Problems with hemoglobin—more common in those of African, Mediterranean, Southeast Asian, or West Indian ethnicity or descent

Symptoms

Anemia may not cause symptoms. In those that have them, it may cause:

  • Feeling weak
  • Feeling tired
  • Lightheadedness or fainting
  • Pale skin in the palms of the hands, lips, nails, and eyelids
  • Rapid heartbeat
  • Trouble breathing
  • Dry hair or hair loss
  • Dry skin or nails
  • Sore, red tongue
  • Cravings for non-food items such as clay, ice, and paper

Diagnosis

Your healthcare provider will ask about your symptoms and health past. Your provider may think you have anemia based on your answers and a physical exam. Blood will be tested on the first visit, and again later in the pregnancy.

Blood is checked for:

  • Hematocrit level—the number of RBCs in the blood compared to total amount of blood
  • Hemoglobin level—the amount of hemoglobin in the blood

Other testing of the blood will help look for a cause.

Treatment

The treatment for anemia will depend on the cause. This may include:

  • Dietary changes—Eating iron-rich foods such as meat, poultry, fish, or dark green vegetables.
  • Iron pills—To help raise iron levels in the blood. Foods that are high in vitamin C, like oranges and other citrus fruits, will help the body take iron in. Coffee, tea, milk, and calcium pills can block iron from getting into the body. Do not use these at the same time that you take an iron pill.
  • Folic acid and vitamin B12 pills—If these are causing anemia.

Prevention

To help lower your chances of anemia in pregnancy:

  • Seek early prenatal care.
  • Take a prenatal vitamin with iron and from the start of pregnancy.
  • Eat foods high in iron such as meats and green vegetables.
  • Eat foods with folic acid such as enriched grains and green vegetables.

RESOURCES

American Pregnancy Association  https://americanpregnancy.org 

The American College of Obstetricians and Gynecologists  https://www.acog.org 

CANADIAN RESOURCES

Canadian Women's Health Network  http://www.cwhn.ca 

The Society of Obstetricians and Gynaecologists of Canada  https://www.sogc.org 

References

ACOG Committee on Obstetrics. ACOG Practice Bulletin No. 78: hemoglobinopathies in pregnancy. Obstet Gynecol. 2007;109(1):229-237. Reaffirmed 2018.

American College of Obstetricians and Gynecologists. ACOG Practice Bulletin No. 95: anemia in pregnancy. Obstet Gynecol. 2008;112(1):201-207. Reaffirmed 2017.

Anemia & pregnancy. American Society of Hematology website. Available at: https://www.hematology.org/Patients/Anemia/Pregnancy.aspx. Accessed April 24, 2019.

Anemia and pregnancy. UCSF Medical Center website. Available at: https://www.ucsfhealth.org/education/anemia%5Fand%5Fpregnancy. Accessed April 24, 2019.

Iron deficiency anemia in adults. EBSCO DynaMed website. Available at:  https://www.dynamed.com/topics/dmp~AN~T115986/Iron-deficiency-anemia-in-adults . Updated March 14, 2019. Accessed April 24, 2019.

Iron deficiency anemia in pregnancy. EBSCO Nursing Reference Center website. Available at:  https://www.ebscohost.com/nursing/products/nursing-reference-center . Updated December 22, 2017. Accessed April 24, 2019.

Treatment of iron deficiency anemia in adults. EBSCO DynaMed website. Available at:  https://www.dynamed.com/topics/dmp~AN~T921914/Treatment-of-iron-deficiency-anemia-in-adults . Updated April 15, 2019. Accessed April 24, 2019.

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