Symptoms of anemia while pregnant

Anemia in Pregnancy | Cedars-Sinai

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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 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 2 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 severe 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 provider if you have questions.

Medical Reviewer: Irina Burd MD PhD

Medical Reviewer: Donna Freeborn PhD CNM FNP

Medical Reviewer: Heather M Trevino BSN RNC

Anemia in Pregnancy: Causes, Symptoms, and Treatment

Written by Jen Uscher

Types of Anemia During Pregnancy

Several types of anemia can develop during pregnancy. These include:

Iron-deficiency anemia
Folate-deficiency anemia
Vitamin B12 deficiency

Here's why these types of anemia may develop:

Iron-deficiency anemia. This type of anemia occurs when the body doesn't have enough iron to produce adequate amounts of hemoglobin. That's a protein in red blood cells. It carries oxygen from the lungs to the rest of the body.

In iron-deficiency anemia, the blood cannot carry enough oxygen to tissues throughout the body.

Iron deficiency is the most common cause of anemia in pregnancy.

Folate-deficiency anemia. Folate is the vitamin found naturally in certain foods like green leafy vegetables A type of B vitamin, the body needs folate to produce new cells, including healthy red blood cells.

During pregnancy, women need extra folate. But sometimes they don't get enough from their diet. When that happens, the body can't make enough normal red blood cells to transport oxygen to tissues throughout the body. Man made supplements of folate are called folic acid.

Folate deficiency can directly contribute to certain types of birth defects, such as neural tube abnormalities (spina bifida) and low birth weight.

Vitamin B12 deficiency. The body needs vitamin B12 to form healthy red blood cells. When a pregnant woman doesn't get enough vitamin B12 from their diet, their body can't produce enough healthy red blood cells. Women who don't eat meat, poultry, dairy products, and eggs have a greater risk of developing vitamin B12 deficiency, which may contribute to birth defects, such as neural tube abnormalities, and could lead to preterm labor.

Blood loss during and after delivery can also cause anemia.

Risk Factors for Anemia in Pregnancy

All pregnant women are at risk for becoming anemic. That's because they need more iron and folic acid than usual. But the risk is higher if you:

Are pregnant with multiples (more than one child)
Have had two pregnancies close together
Vomit a lot because of morning sickness
Are a pregnant teenager
Don't eat enough foods that are rich in iron
Had anemia before you became pregnant

Symptoms of Anemia During Pregnancy

The most common symptoms of anemia during pregnancy are:

Pale skin, lips, and nails
Feeling tired or weak
Dizziness
Shortness of breath
Rapid heartbeat
Trouble concentrating

In the early stages of anemia, you may not have obvious symptoms. And many of the symptoms are ones that you might have while pregnant even if you're not anemic. So be sure to get routine blood tests to check for anemia at your prenatal appointments.

Risks of Anemia in Pregnancy

Severe or untreated iron-deficiency anemia during pregnancy can increase your risk of having:

A preterm or low-birth-weight baby
A blood transfusion (if you lose a significant amount of blood during delivery)
Postpartum depression
A baby with anemia
A child with developmental delays

Untreated folate deficiency can increase your risk of having a:

Preterm or low-birth-weight baby
Baby with a serious birth defect of the spine or brain (neural tube defects)

Untreated vitamin B12 deficiency can also raise your risk of having a baby with neural tube defects.

Tests for Anemia

During your first prenatal appointment, you'll get a blood test so your doctor can check whether you have anemia. Blood tests typically include:

Hemoglobin test. It measures the amount of hemoglobin -- an iron-rich protein in red blood cells that carries oxygen from the lungs to tissues in the body.
Hematocrit test. It measures the percentage of red blood cells in a sample of blood.

If you have lower than normal levels of hemoglobin or hematocrit, you may have iron-deficiency anemia. Your doctor may check other blood tests to determine if you have iron deficiency or another cause for your anemia.

Even if you don't have anemia at the beginning of your pregnancy, your doctor will most likely recommend that you get another blood test to check for anemia in your second or third trimester.

Treatment for Anemia

If you are anemic during your pregnancy, you may need to start taking an iron supplement and/or folic acid supplement in addition to your prenatal vitamins. Your doctor may also suggest that you add more foods that are high in iron and folic acid to your diet.

In addition, you'll be asked to return for another blood test after a specific period of time so your doctor can check that your hemoglobin and hematocrit levels are improving.

To treat vitamin B12 deficiency, your doctor may recommend that you take a vitamin B12 supplement.

The doctor may also recommend that you include more animal foods in your diet, such as:

meat
eggs
dairy products

Your OB may refer you to a hematologist, a doctor who specializes in anemia/ blood issues. The specialist may see you throughout the pregnancy and help your OB manage the anemia.

Preventing Anemia

To prevent anemia during pregnancy, make sure you get enough iron. Eat well-balanced meals and add more foods that are high in iron to your diet.

Aim for at least three servings a day of iron-rich foods, such as:

lean red meat, poultry, and fish
leafy, dark green vegetables (such as spinach, broccoli, and kale)
iron-enriched cereals and grains
beans, lentils, and tofu
nuts and seeds
eggs

Foods that are high in vitamin C can help your body absorb more iron. These include:

citrus fruits and juices
strawberries
kiwis
tomatoes
bell peppers

Try eating those foods at the same time that you eat iron-rich foods. For example, you could drink a glass of orange juice and eat an iron-fortified cereal for breakfast.

Also, choose foods that are high in folate to help prevent folate deficiency. These include:

leafy green vegetables
citrus fruits and juices
dried beans
breads and cereals fortified with folic acid

Follow your doctor's instructions for taking a prenatal vitamin that contains a sufficient amount of iron and folic acid.

Vegetarians and vegans should talk with their doctor about whether they should take a vitamin B12 supplement when they're pregnant and breastfeeding.

Health & Pregnancy Guide

Getting Pregnant
First Trimester
Second Trimester
Third Trimester
Labor and Delivery
Pregnancy Complications
All Guide Topics

How to determine anemia during pregnancy?

During pregnancy, it is necessary to check a number of indicators that will provide information about the state of the female body. Some of the important indicators are the level of hemoglobin and the level of iron in the blood.

Anemia is a condition characterized by a decrease in the number of red blood cells and a decrease in the level of hemoglobin per unit volume of blood.

The World Health Organization and the American College of Obstetricians and Gynecologists confirm anemia in pregnancy for the following hemoglobin readings:

For the first trimester: Hb <11 g/dl.
For the second trimester: Hb <10.5 g/dl.
For third trimester: Hb <11 g/dl.

Complications arising from iron deficiency anemia.

chronic fetal hypoxia
fetal growth retardation.
miscarriage
weakness of labor activity
early postpartum hemorrhage
hypogalactia
purulent-septic complications in the postpartum period.

The most common causes of anemia.

1. Iron deficiency in the body.

Factors affecting the development of iron deficiency anemia:

Low intake of iron from food (vegetarianism, malnutrition)
History of profuse menstruation.
Chronic diseases of the gastrointestinal tract, in which the absorption of nutrients, including trace elements, is impaired.
Infectious diseases.
Short interval between pregnancies.

2. Deficiency of folate compounds of folic acid in the body.

Insufficient intake from food - during prolonged cooking, a significant part of the folates is destroyed.

Alcohol consumption - alcohol interferes with the absorption of folate.
Intestinal malabsorption - in diseases of the gastrointestinal tract.

How does anemia appear during pregnancy?

Early symptoms of anemia development are not pronounced - it is easy fatigue, weakness, slight dizziness, easy shortness of breath during exercise, heart palpitations. With severe anemia, pallor appears.

Iron deficiency anemia can provoke the development of preterm labor, and affects the intrauterine development of the fetus.

Diagnosis of anemia during pregnancy.

Specialists of the SANAS medical center take and analyze blood, measure the patient's serum iron, ferritin and transferrin. Iron deficiency anemia is confirmed when a reduced level of iron and ferritin is detected, against the background of elevated serum transferrin.

Treatment of iron deficiency anemia.

For the treatment of iron deficiency anemia, ferrous sulfate preparations are prescribed in the form of tablets. Since some pregnant women cannot fully absorb enough iron from tablets, parenteral administration of drugs (eg, intramuscular injections) may be prescribed.

During treatment, weekly blood sampling for hematocrit and hemoglobin is mandatory, in the absence of changes in the analyzes, it is worth suspecting the presence of folate deficiency.

Folate deficiency is determined by its level in the blood serum. Treat folate deficiency anemia during pregnancy by taking folic acid supplements. Such drugs can be prescribed to pregnant women for prevention purposes and to those who are just planning a pregnancy.

Prevention of iron deficiency anemia.

The best prevention of anemia is to check iron stores, determine the level of hemoglobin at the stage of pregnancy planning. If any deviations are detected, the level of iron in the blood is corrected, foods with a high iron content are added to the diet, vitamin-mineral complexes can be prescribed.

Medical center "SANAS" employs qualified hematologists, to whom you can entrust your health.

Why anemia is dangerous during pregnancy and how it is treated

November 21, 2020 Likbez Health

Low hemoglobin in the mother has a bad effect on the development of the child.

What is anemia

Anemia, or anemia, is a disease in which the concentration of hemoglobin in the blood decreases. It is a protein inside red blood cells, which includes iron. For oxygen, it acts as a magnet. If hemoglobin becomes low, oxygen does not find points for attachment, so organs and tissues receive less of it and begin to suffocate, their work is disrupted.

Anemia is especially dangerous during pregnancy. Due to low hemoglobin, immunity worsens and infections attack more often, and during childbirth severe bleeding can begin and the woman will die.

Anemia is less dangerous for a child. Its hemoglobin is different in structure from what is in the mother's blood and can transport more oxygen. Therefore, with mild anemia, the fetus will not suffer. But if the disease is not treated, it turns into a severe form, due to which the child can be born prematurely, have low body weight and even die.

What are the symptoms of anemia during pregnancy

Anemia can not always be recognized by external manifestations. Pregnant women, unlike other women, get more tired, often feel dizzy and weak, and these are one of the first signs of low hemoglobin. Other symptoms may also appear:

pale or yellowish skin;
headache;
cold hands and feet;
brittle nails, hair loss;
poor appetite;
shortness of breath;
palpitations;
bleeding gums.

Because of anemia, some pregnant women begin to eat chalk, sand, clay, someone enjoys the smell of fresh paint, glue or gasoline.

Why anemia occurs during pregnancy and how it is treated

You can notice anemia by a general blood test. Therefore, pregnant women take it several times during the entire period of observation at the gynecologist. If the doctor sees deviations from the norm, he will refer to the therapist. In severe cases, a woman is advised to visit a hematologist.

Depending on the causes, scientists distinguish several types of anemia. Each of them needs its own special treatment, so first the woman takes blood tests.

Iron deficiency

In 90% of cases, anemia occurs during pregnancy due to a lack of iron in the body. A woman needs this element twice as much as before conception, in order to provide the growing fetus with oxygen. But under the influence of certain factors, her body cannot maintain a normal concentration of hemoglobin. This happens if:

Increased iron consumption. For example, with periodic bleeding from the gums, with hemorrhoids or stomach ulcers, blood cells are lost and iron along with them.
Iron absorption is impaired. If a woman has gastritis or the concentration of hydrochloric acid in the stomach is reduced, the microelement does not penetrate well into the blood.
Not enough iron. Those who refuse meat, eat little greens, may experience iron deficiency anemia.